Provider Demographics
NPI:1902263031
Name:SPEECH'EM
Entity Type:Organization
Organization Name:SPEECH'EM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP-A
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-606-7982
Mailing Address - Street 1:7129 N. SARIVAL RD.
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7129 N SARIVAL AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9796
Practice Address - Country:US
Practice Address - Phone:623-606-7982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health