1497360317 NPI number — ROBYN ELOUISE BRADY MA, CCC-SLP

Table of content: KAITLIN LAWSON KALNITZ APN (NPI 1619578523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497360317 NPI number — ROBYN ELOUISE BRADY MA, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADY
Provider First Name:
ROBYN
Provider Middle Name:
ELOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAIRNS
Provider Other First Name:
ROBYN
Provider Other Middle Name:
ELOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497360317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1829 N GRAND
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85201-1706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-472-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1829 N GRAND
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85201-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-472-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP13145 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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