Provider Demographics
NPI:1447902887
Name:REDDICK, ANN MARIE (SLP-A)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:REDDICK
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:ANNMARIE
Other - Middle Name:
Other - Last Name:REDDICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP-A
Mailing Address - Street 1:4650 WEST SWEETWATER AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12202 NORTH 21ST AVENUE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:602-347-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA13820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist