Provider Demographics
NPI:1831376466
Name:POLESKY, RONDA DIANE (MS,CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:RONDA
Middle Name:DIANE
Last Name:POLESKY
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7239 S 41ST LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-3507
Mailing Address - Country:US
Mailing Address - Phone:480-330-4575
Mailing Address - Fax:
Practice Address - Street 1:7255 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-9201
Practice Address - Country:US
Practice Address - Phone:480-981-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist