Provider Demographics
NPI:1912374588
Name:WOOLLEY, BECKY
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:WOOLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 S 39TH ST UNIT 80
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3840
Mailing Address - Country:US
Mailing Address - Phone:623-227-6067
Mailing Address - Fax:
Practice Address - Street 1:1950 E LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-0821
Practice Address - Country:US
Practice Address - Phone:480-274-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA95582355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant