Provider Demographics
NPI:1255701843
Name:BUSTAMANTE, LORENIA (SLPA)
Entity type:Individual
Prefix:
First Name:LORENIA
Middle Name:
Last Name:BUSTAMANTE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 W CAMPO BELLO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-1870
Mailing Address - Country:US
Mailing Address - Phone:602-573-1401
Mailing Address - Fax:
Practice Address - Street 1:3227 W CAMPO BELLO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-1870
Practice Address - Country:US
Practice Address - Phone:602-573-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA96232355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant