Provider Demographics
NPI:1710248042
Name:SAGUARO CENTER FOR SPEECH & LANGUAGE PLLC
Entity Type:Organization
Organization Name:SAGUARO CENTER FOR SPEECH & LANGUAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FABIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCH KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-730-8428
Mailing Address - Street 1:1011 N CRAYCROFT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-7309
Mailing Address - Country:US
Mailing Address - Phone:520-730-8428
Mailing Address - Fax:520-300-8328
Practice Address - Street 1:1011 N CRAYCROFT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-7309
Practice Address - Country:US
Practice Address - Phone:520-730-8428
Practice Address - Fax:520-300-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ713704Medicaid