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Organization
SOS PHOENIX LLC
Active
Organization
SOS PHOENIX LLC
Active
Other names
Success on the Spectrum
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TED HOLMGREN (OWNER, GENERAL MANAGER)
(801) 635-6208
Entity
Organization
Contact information
Practice address
1303 S LONGMORE STE 2, MESA, AZ 85202-9607
(801) 635-6208
Mailing address
5018 E HANNIBAL ST, MESA, AZ 85205-6879
(801) 635-6208
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
11/30/2022
Last updated
11/30/2022
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