Provider Demographics
NPI:1538245527
Name:TRUNZO, MARY JANE (MA, CCC-SP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:TRUNZO
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 N. 36TH STREET
Mailing Address - Street 2:#125
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018
Mailing Address - Country:US
Mailing Address - Phone:602-224-0202
Mailing Address - Fax:602-224-0010
Practice Address - Street 1:4545 N. 36TH STREET
Practice Address - Street 2:#125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:602-224-0202
Practice Address - Fax:602-224-0010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist