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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