Provider Demographics
NPI:1477617041
Name:DOELL, ALICIA MARY (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:MARY
Last Name:DOELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 W CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-2667
Mailing Address - Country:US
Mailing Address - Phone:480-650-9665
Mailing Address - Fax:
Practice Address - Street 1:1471 N ELISEO FELIX JR WAY
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1208
Practice Address - Country:US
Practice Address - Phone:602-773-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4003SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ812504Medicaid