Provider Demographics
NPI:1770837940
Name:DEANDA, LUPE PISANO (SLPA)
Entity Type:Individual
Prefix:
First Name:LUPE
Middle Name:PISANO
Last Name:DEANDA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7012 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5604
Mailing Address - Country:US
Mailing Address - Phone:602-625-3571
Mailing Address - Fax:602-955-0245
Practice Address - Street 1:7012 N 22ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5604
Practice Address - Country:US
Practice Address - Phone:602-625-3571
Practice Address - Fax:602-955-0245
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA79352355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ94-1687665OtherE.I.N.