Intercept Speech and Language, LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

SLP4673 Issued in AZ

Legal business name

INTERCEPT SPEECH AND LANGUAGE, LLC

Practice address

1201 E Fry Blvd
Suite #1
Sierra Vista, AZ 85635-2600

Phone

(520) 459-8258

Fax

(520) 459-8619

NPI assigned

Oct 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Corneta E. Kelley, M.A.,CCC-SLP

Title

Owner

Phone

(520) 459-8258

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247011200000",
    "number": "1679656409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13428 MAXELLA AVE # 228",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925620",
            "telephone_number": "520-459-8258",
            "fax_number": "520-459-8619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 E FRY BLVD",
            "address_2": "SUITE #1",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352600",
            "telephone_number": "520-459-8258",
            "fax_number": "520-459-8619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCEPT SPEECH AND LANGUAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2009-07-08",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "CORNETA",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-459-8258",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.A.,CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "AZ",
            "license": "SLP4673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "968141",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.