Provider Demographics
NPI:1689014813
Name:SUKHODOLSKY, ALBINA TZIPPORAH (SLP)
Entity type:Individual
Prefix:
First Name:ALBINA
Middle Name:TZIPPORAH
Last Name:SUKHODOLSKY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ALBINA
Other - Middle Name:TZIPPORAH
Other - Last Name:UVAYDOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6820 N 13TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1120
Mailing Address - Country:US
Mailing Address - Phone:314-406-5893
Mailing Address - Fax:
Practice Address - Street 1:6820 N 13TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1120
Practice Address - Country:US
Practice Address - Phone:314-406-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP8412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist