Provider Demographics
NPI:1568989374
Name:MERKEL, MANDY GAYLE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:MANDY
Middle Name:GAYLE
Last Name:MERKEL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 WALNUT ST APT 4
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-1353
Mailing Address - Country:US
Mailing Address - Phone:816-769-8603
Mailing Address - Fax:
Practice Address - Street 1:5111 N SCOTTSDALE RD STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7076
Practice Address - Country:US
Practice Address - Phone:602-751-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016021285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist