Organization
INTERCEPT SPEECH AND LANGUAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CORNETA E. KELLEY M.A.,CCC-SLP (OWNER)
(520) 459-8258
Entity
Organization
Contact information
Practice address
1201 E FRY BLVD, SUITE #1, SIERRA VISTA, AZ 85635-2600
(520) 459-8258
(520) 459-8619
Mailing address
13428 MAXELLA AVE # 228, MARINA DEL REY, CA 90292-5620
(520) 459-8258
(520) 459-8619
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
SLP4673
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
968141
AHCCCS
AZ
Enumeration date
10/23/2006
Last updated
07/08/2009
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