Provider Demographics
NPI:1891030318
Name:SPEECH THERAPY GROUP OF TUCSON PLLC
Entity Type:Organization
Organization Name:SPEECH THERAPY GROUP OF TUCSON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:MEADES
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:520-232-2021
Mailing Address - Street 1:1830 E BROADWAY BLVD
Mailing Address - Street 2:SUITE 124-143
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5966
Mailing Address - Country:US
Mailing Address - Phone:520-232-2021
Mailing Address - Fax:520-232-2553
Practice Address - Street 1:1830 E BROADWAY BLVD
Practice Address - Street 2:SUITE 124-143
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5966
Practice Address - Country:US
Practice Address - Phone:520-232-2021
Practice Address - Fax:520-232-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP 5096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ766943Medicaid