Basic Information
| Provider Information | |||||||||
| NPI: | 1891863908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORMSON | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 N CENTRAL AVE | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063729 | ||||||||
| FaxNumber: | 6027989412 | ||||||||
| Practice Location | |||||||||
| Address1: | 124 W THOMAS RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024064185 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | DA628 | AZ | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.