Therese Church-Nystrom

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP10414 Issued in AZ

Practice address

4545 N 36TH St Ste 125a
Phoenix, AZ 85018-3456

Phone

(602) 224-0202

Fax

(602) 224-0010

NPI assigned

Jan 6, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Arizona Institute for Communication & Cognitive Disorders Inc

  • Speech-Language Pathologist
  • Phoenix, AZ
  • NPI 1013134170
  NPD

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

{
    "created_epoch": "1483660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1710422340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20250 N 67TH AVE APT 2162",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086641",
            "telephone_number": "480-603-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 N 36TH ST STE 125A",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183456",
            "telephone_number": "602-224-0202",
            "fax_number": "602-224-0010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6991 E Camelback Rd",
            "address_2": "Suite D-300",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852512432",
            "country_code": "US",
            "telephone_number": "623-349-1373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHURCH-NYSTROM",
        "first_name": "THERESE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-06",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLP10414",
            "primary": true
        },
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "AZ",
            "license": "10414",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sonia K Chung, OD
• Stephen Andrew Chung, MD
• Steve S Chung, M.D.
• Susan A. Chung, DPT
• TSZ Chun Chung
• Ashley Elizabeth Church, DPT
• Eric Jack Church, M. D.
• Kaitelyn Church
• Kendra Dawn Church, FNP-C
• Danyelle Christine Churchill, AGACNP-BC

• Speech-Language Pathologist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Speech-Language Pathologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.