Individual
THERESE CHURCH-NYSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4545 N 36TH ST STE 125A, PHOENIX, AZ 85018-3456
(602) 224-0202
(602) 224-0010
Mailing address
20250 N 67TH AVE APT 2162, GLENDALE, AZ 85308-6641
(480) 603-5115
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
10414
AZ
235Z00000X
Speech-Language Pathologist
Primary
SLP10414
AZ
Other
Enumeration date
01/06/2017
Last updated
07/21/2022
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