Basic Information
| Provider Information | |||||||||
| NPI: | 1801085543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANLANDINGHAM | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | LEAH | ||||||||
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| Credential: | MA CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2040 E HEARTWOOD LN | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850222986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026151986 | ||||||||
| FaxNumber: | 4807045807 | ||||||||
| Practice Location | |||||||||
| Address1: | 25615 N RANCH GATE RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852552141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805027726 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2007 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP4253 | AZ | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SLP8115 | AZ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.