NPIMap

Stacy Jordan Trainor, SLP

Individual provider Active NPI Speech-Language Pathologist · Phoenix, AZ

NPI 1104065309 · NPPES record last updated Feb 11, 2009

Key facts

NPI
1104065309
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
SLP5827 (AZ)
Practice address
1226 W Osborn Rd
Phoenix, AZ 85013-3618
Phone
(602) 707-8604
Fax
(602) 707-2040
NPI assigned
Feb 11, 2009
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
SLP5827AZMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Osborn School District Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SLP5827 AZ Yes

Addresses

Primary practice location

1226 W Osborn Rd
Phoenix, AZ 85013-3618

Mailing address

1226 W Osborn Rd
Phoenix, AZ 85013-3618
Phone (602) 707-8604

Other names

  • Miss Stacy Jordan Holm Former name

Other providers in Phoenix, AZ

All providers in Phoenix, AZ · Speech-Language Pathologist in Arizona

Sources for this page

Verify at the official NPI Registry.