Provider Demographics
NPI:1689705956
Name:MONTOYA, ANNA M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11586 W PALO VERDE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1737
Mailing Address - Country:US
Mailing Address - Phone:623-580-0139
Mailing Address - Fax:
Practice Address - Street 1:5656 E GRANT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2210
Practice Address - Country:US
Practice Address - Phone:520-885-9567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP#4297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ839681Medicaid