| |
6425 W Constance Way, Laveen, AZ 85339-2798 | |
(602) 705-8705 | |
(602) 323-2241 |
Full Name | |
---|---|
Type | Facility |
Speciality | Audiologist |
Location | 6425 W Constance Way, Laveen, Arizona |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1154587590 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
231H00000X | Audiologist | AUD5402 (Arizona) | Primary |
235Z00000X | Speech-language Pathologist | SLPL4532 (Arizona) | Secondary |
Mailing Address | Practice Location Address |
---|---|
6425 W Constance Way, Laveen, AZ 85339-2798 Ph: (602) 705-8705 | 6425 W Constance Way, Laveen, AZ 85339-2798 Ph: (602) 705-8705 |
Mrs. Susan Eileen Van Wie, CCC/A Audiologist Medicare: Not Enrolled in Medicare Practice Location: 6425 W Constance Way, Laveen, AZ 85339 Phone: 602-705-8705 |