Bryan Acosta, M.S., CCC-SLP

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

NPI 1558039461 · NPPES record last updated Sep 3, 2021

Key facts

NPI
1558039461
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
SLP12521 (AZ)
Practice address
7650 N 43Rd Ave
Glendale, AZ 85301-1661
Phone
(623) 435-6000
NPI assigned
Sep 3, 2021
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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
SLP12521AZMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Glendale Union High School Dist Past
since Sep 5, 2021
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist
Group: 193400000X SINGLE SPECIALTY GROUP
235Z00000X SLP12521 AZ Yes

Addresses

Primary practice location

7650 N 43Rd Ave
Glendale, AZ 85301-1661

Mailing address

624 W Indianola Ave Unit 115
Phoenix, AZ 85013-3370

Other providers in Glendale, AZ

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

Sources for this page

Verify at the official NPI Registry.