Provider Demographics
NPI:1871862151
Name:FUSION THERAPIES PLLC
Entity Type:Organization
Organization Name:FUSION THERAPIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CCC-SLP
Authorized Official - Phone:623-256-1728
Mailing Address - Street 1:17333 W DURANGO ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1704
Mailing Address - Country:US
Mailing Address - Phone:623-256-1728
Mailing Address - Fax:
Practice Address - Street 1:7747 W DEER VALLEY RD STE 255
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2124
Practice Address - Country:US
Practice Address - Phone:623-256-1728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
AZSLP4344252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty