Provider Demographics
NPI:1013134170
Name:ARIZONA INSTITUTE FOR COMMUNICATION & COGNITIVE DISORDERS INC
Entity Type:Organization
Organization Name:ARIZONA INSTITUTE FOR COMMUNICATION & COGNITIVE DISORDERS INC
Other - Org Name:ARIZONA INSTITUTE FOR COMMUNICATION & COGNITIVE DISORDERS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUNZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-224-0202
Mailing Address - Street 1:4545 N 36TH ST STE 125A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3456
Mailing Address - Country:US
Mailing Address - Phone:602-224-2020
Mailing Address - Fax:602-393-0141
Practice Address - Street 1:4545 N 36TH ST STE 125A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3456
Practice Address - Country:US
Practice Address - Phone:602-224-0202
Practice Address - Fax:602-393-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty