Provider Demographics
NPI:1740616267
Name:NEWHARD, PETRONELLA (MS, CCC-SLP, SLT)
Entity Type:Individual
Prefix:MS
First Name:PETRONELLA
Middle Name:
Last Name:NEWHARD
Suffix:
Gender:F
Credentials:MS, CCC-SLP, SLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-5527
Mailing Address - Country:US
Mailing Address - Phone:928-919-4752
Mailing Address - Fax:
Practice Address - Street 1:304 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2367
Practice Address - Country:US
Practice Address - Phone:928-919-4752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA#84002355S0801X
AZSLP12310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ010920614Medicaid