Provider Demographics
NPI:1184772469
Name:GIORSETTI, THERESE ANN (MA CCC SLP)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:ANN
Last Name:GIORSETTI
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:ANN
Other - Last Name:SUDBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3305 N HARRIS WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1727
Mailing Address - Country:US
Mailing Address - Phone:928-779-3088
Mailing Address - Fax:928-773-4138
Practice Address - Street 1:4000 N CUMMINGS ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-2437
Practice Address - Country:US
Practice Address - Phone:928-773-4140
Practice Address - Fax:928-773-4138
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ01035929OtherASHA ACCOUNT NUMBER
AZSLP1526OtherSLP LICENSE NUMBER