Individual
LISA FIELD THUNBORG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
422 N LA PAZ ST, DEWEY, AZ 86327-7147
(928) 899-0440
Mailing address
4786 N EDGEMONT RD, PRESCOTT VALLEY, AZ 86314-9270
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SLPA7858
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLPA7858
AZ DEPARTMENT OF HEALTH SERVICES
AZ
Enumeration date
06/22/2012
Last updated
06/26/2012
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