Individual
MS. ILENE SECRIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
42901 N 45TH AVE, PHOENIX, AZ 85087-7002
(623) 376-5200
Mailing address
8195 MASTERS LN, FLAGSTAFF, AZ 86004-1212
(928) 853-4054
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP0966
AZ
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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