Provider Demographics
NPI:1891831509
Name:PRESCOTT SPEECH & LANGUAGE SERVICES INC.
Entity Type:Organization
Organization Name:PRESCOTT SPEECH & LANGUAGE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:POUQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:928-445-1309
Mailing Address - Street 1:PO BOX 11312
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-1312
Mailing Address - Country:US
Mailing Address - Phone:928-445-1309
Mailing Address - Fax:928-445-0914
Practice Address - Street 1:812 VALLEY ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1826
Practice Address - Country:US
Practice Address - Phone:928-445-1309
Practice Address - Fax:928-445-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 4011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ855091OtherAHCCCS
AZ03-6590Medicare ID - Type UnspecifiedPROVIDER NUMBER