1255513818 NPI number — STEPHANIE LEIGH ADAMOVICH PH.D., CCC-A

Table of content: STEPHANIE LEIGH ADAMOVICH PH.D., CCC-A (NPI 1255513818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255513818 NPI number — STEPHANIE LEIGH ADAMOVICH PH.D., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMOVICH
Provider First Name:
STEPHANIE
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D., CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WIXOM
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255513818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4838 E BASELINE RD
Provider Second Line Business Mailing Address:
STE 126
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85206-4673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-965-2373
Provider Business Mailing Address Fax Number:
480-965-0076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ARIZONA STATE UNIVERSITY SPEECH AND
Provider Second Line Business Practice Location Address:
975 S. MYRTLE AVE
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85287-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-965-2373
Provider Business Practice Location Address Fax Number:
480-965-0076
Provider Enumeration Date:
12/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  DA7605 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237600000X , with the licence number: DA7605 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)