Provider Demographics
NPI:1013169515
Name:ROWLETT, ALICIA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ROWLETT
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 1:3400 N ALMA SCHOOL RD APT 2034
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8000
Mailing Address - Country:US
Mailing Address - Phone:719-671-7172
Mailing Address - Fax:
Practice Address - Street 1:3400 N ALMA SCHOOL RD APT 2034
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8000
Practice Address - Country:US
Practice Address - Phone:719-671-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3636967235Z00000X
AZSLPL5283235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLPL5283OtherARIZONA DEPARTMENT OF HEALTH SERVICES
AZ3636967OtherARIZONA DEPARTMENT OF EDUCATION