Basic Information
| Provider Information | |||||||||
| NPI: | 1710486261 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NATKIN | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | DIANE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 N ARIZONA AVE APT 1002 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852257147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807517985 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5314 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850142805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775006 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2018 | ||||||||
| LastUpdateDate: | 02/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | SLPA10934 | AZ | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
ID Information
| ID | Type | State | Issuer | Description | SLPA10934 | 05 | AZ | MEDICAID |