Individual
MRS. CAROL CANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5130 W GROVERS AVE, GLENDALE, AZ 85308-1300
(602) 467-6522
Mailing address
4405 W CATHY CIR, GLENDALE, AZ 85308-3534
(602) 938-2162
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLPL5028
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
958291
AHCCCS PROVIDER ID NUMBER
AZ
Enumeration date
04/04/2007
Last updated
07/08/2007
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