Provider Demographics
NPI:1851477228
Name:NORTHERN ARIZONA SPEECH-LANGUAGE SERVICE PROVIDERS, PLLC
Entity Type:Organization
Organization Name:NORTHERN ARIZONA SPEECH-LANGUAGE SERVICE PROVIDERS, PLLC
Other - Org Name:NORTHERN ARIZONA SPEECH/LANGUAGE SERVICE PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:ZELLER
Authorized Official - Last Name:KOHLBECK
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MS, CCC-SLP
Authorized Official - Phone:928-773-0895
Mailing Address - Street 1:10550 N NIGHTHAWK LANE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3344
Mailing Address - Country:US
Mailing Address - Phone:928-773-0895
Mailing Address - Fax:928-773-0896
Practice Address - Street 1:10550 N NIGHTHAWK LANE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3344
Practice Address - Country:US
Practice Address - Phone:928-773-0895
Practice Address - Fax:928-773-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ713752251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health