Provider Demographics
NPI:1932661543
Name:ACOSTA, CHEYENNE LEIGH
Entity Type:Individual
Prefix:MRS
First Name:CHEYENNE
Middle Name:LEIGH
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:LEIGH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4510 E BANNER GATEWAY DR APT 2062
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4755
Mailing Address - Country:US
Mailing Address - Phone:520-507-1691
Mailing Address - Fax:
Practice Address - Street 1:4309 E FLORIAN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2798
Practice Address - Country:US
Practice Address - Phone:480-757-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant