| NPI | 1871862151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JENKINS Speech Language Pathologist 623-256-1728 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: AZ SLP4344) |
| Additional Taxonomies | 171W00000X Contractor |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2011-12-15 |