Provider Demographics
NPI:1447304092
Name:DANZIG, LORI TALLEY (SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:TALLEY
Last Name:DANZIG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11685 E FOUR PEAKS RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-8017
Mailing Address - Country:US
Mailing Address - Phone:480-563-0168
Mailing Address - Fax:
Practice Address - Street 1:12575 E VIA LINDA
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-4310
Practice Address - Country:US
Practice Address - Phone:480-484-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP051235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist