Organization
SOUTHWEST ORAL MYOFUNCTIONAL SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT M NELSON (OWNER)
(480) 969-8265
Entity
Organization
Contact information
Practice address
2619 E HALE ST, MESA, AZ 85213-4155
(480) 969-8265
Mailing address
2045 S VINEYARD, BLDG 5, MESA, AZ 85210-6889
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
10/25/2011
Last updated
10/25/2011
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