| Southwest Center For Communication Disorders | |
|
802 Ainsworth Dr Suite C Prescott AZ 86301-1630 | |
| (928) 777-0172 | |
| (928) 777-0174 |
| Full Name | Southwest Center For Communication Disorders |
|---|---|
| Speciality | Speech-language Pathologist |
| Location | 802 Ainsworth Dr, Prescott, Arizona |
| Authorized Official Name and Position | Lisa Crujido (OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 9287770172 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Center For Communication Disorders 802 Ainsworth Dr Suite C Prescott AZ 86301-1630 Ph: (928) 777-0172 | Southwest Center For Communication Disorders 802 Ainsworth Dr Suite C Prescott AZ 86301-1630 Ph: (928) 777-0172 |
| NPI Number | 1336190115 |
|---|---|
| Provider Enumeration Date | 05/15/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336190115 | NPI | - | NPPES |
| 036593 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW-3469 (Arizona) | Primary |
| 235Z00000X | Speech-language Pathologist | 0732 (Arizona) | Primary |
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