Provider Demographics
NPI:1700912391
Name:GARLAND, BREETA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BREETA
Middle Name:
Last Name:GARLAND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5818
Mailing Address - Country:US
Mailing Address - Phone:480-668-2750
Mailing Address - Fax:480-668-1917
Practice Address - Street 1:108 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5818
Practice Address - Country:US
Practice Address - Phone:480-668-2750
Practice Address - Fax:480-668-1917
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2043235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0140920OtherBLUE CROSS BLUE SHIELD
AZ908775Medicaid
AZ042127Medicare UPIN