Provider Demographics
NPI:1245485630
Name:LENORA ANDERSON SPEECH PATHOLOGY SERVICES, INC.
Entity type:Organization
Organization Name:LENORA ANDERSON SPEECH PATHOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LENORA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:623-203-5348
Mailing Address - Street 1:16182 W PICCADILLY RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8082
Mailing Address - Country:US
Mailing Address - Phone:623-203-5348
Mailing Address - Fax:623-505-5350
Practice Address - Street 1:16182 W PICCADILLY RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-8082
Practice Address - Country:US
Practice Address - Phone:623-203-5348
Practice Address - Fax:623-505-5350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty