Basic Information
| Provider Information | |||||||||
| NPI: | 1538707906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | MANDY | ||||||||
| MiddleName: | RODABOUGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21934 N 106TH LN | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853835724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232178719 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8765 W KELTON LN STE 116 | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853825008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239774911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2019 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
No ID Information.