Provider Demographics
NPI:1740343508
Name:CARROLL, MICHELE (SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10553 E MEADOWHILL DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-1733
Mailing Address - Country:US
Mailing Address - Phone:480-609-1469
Mailing Address - Fax:
Practice Address - Street 1:930 W SOUTHERN AVE
Practice Address - Street 2:STE #10
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4938
Practice Address - Country:US
Practice Address - Phone:480-835-0857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ455099Medicaid