Provider Demographics
NPI:1922531045
Name:MARIPOSA SPEECH SERVICES LLC
Entity Type:Organization
Organization Name:MARIPOSA SPEECH SERVICES LLC
Other - Org Name:MARIPOSA THERAPY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:LA BRIE
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP, MED
Authorized Official - Phone:602-828-2619
Mailing Address - Street 1:3145 E CHANDLER BLVD
Mailing Address - Street 2:SUITE 110-117
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8702
Mailing Address - Country:US
Mailing Address - Phone:602-828-2619
Mailing Address - Fax:
Practice Address - Street 1:1 W ELLIOT RD STE 109
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1310
Practice Address - Country:US
Practice Address - Phone:480-374-4341
Practice Address - Fax:480-247-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1922531045Medicaid