Provider Demographics
NPI:1841480167
Name:ANDERSON, LENORA (MS CCC SLP)
Entity type:Individual
Prefix:MS
First Name:LENORA
Middle Name:
Last Name:ANDERSON
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 1:16182 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 ROAD
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
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ245616OtherAHCCCS PROVIDER NUMBER