Provider Demographics
NPI:1013305549
Name:THOMAS, ANNA-ALYSE TELLEZ (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANNA-ALYSE
Middle Name:TELLEZ
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ANNA-ALYSE
Other - Middle Name:
Other - Last Name:TELLEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:544 S SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6735
Mailing Address - Country:US
Mailing Address - Phone:520-405-6184
Mailing Address - Fax:
Practice Address - Street 1:4100 S LINDSAY RD STE 113
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1507
Practice Address - Country:US
Practice Address - Phone:480-219-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSA8984235Z00000X
AZSLP8984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist