Provider Demographics
NPI:1780202101
Name:CLOUSE, TORI BAILEY (CF-SLP)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:BAILEY
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:522 N FALCON DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-7649
Mailing Address - Country:US
Mailing Address - Phone:480-787-1161
Mailing Address - Fax:
Practice Address - Street 1:5437 E FORGE AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2947
Practice Address - Country:US
Practice Address - Phone:480-787-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA123512355S0801X
AZTSLP12351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant