Provider Demographics
NPI:1881470243
Name:NILSON, ANITA SAMONE
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:SAMONE
Last Name:NILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 N 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-3324
Mailing Address - Country:US
Mailing Address - Phone:602-347-2148
Mailing Address - Fax:602-347-2120
Practice Address - Street 1:9650 N 39TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3324
Practice Address - Country:US
Practice Address - Phone:602-347-2148
Practice Address - Fax:602-347-2120
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ147172355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant