Provider Demographics
NPI:1861813131
Name:ABC THERAPY SERVICES
Entity Type:Organization
Organization Name:ABC THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:520-349-7451
Mailing Address - Street 1:4735 N TOMNITZ PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-7403
Mailing Address - Country:US
Mailing Address - Phone:520-349-7451
Mailing Address - Fax:
Practice Address - Street 1:4735 N TOMNITZ PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-7403
Practice Address - Country:US
Practice Address - Phone:520-349-7451
Practice Address - Fax:520-742-5693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP#1086OtherNPI 1508084682
AZSLP#1228OtherNPI 1326252487