Basic Information
| Provider Information | |||||||||
| NPI: | 1831376466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLESKY | ||||||||
| FirstName: | RONDA | ||||||||
| MiddleName: | DIANE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S.,CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7239 S 41ST LN | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850413507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803304575 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7255 E BROADWAY RD | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852089201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809818844 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2008 | ||||||||
| LastUpdateDate: | 01/25/2008 | ||||||||
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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 | 235Z00000X | SLP0288 | AZ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.