Provider Demographics
NPI:1750429478
Name:GAVLE, RITA RENEE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:RITA
Middle Name:RENEE
Last Name:GAVLE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14015 N 94TH ST APT 1034
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3725
Mailing Address - Country:US
Mailing Address - Phone:480-751-8036
Mailing Address - Fax:
Practice Address - Street 1:14015 N 94TH ST APT 1034
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3725
Practice Address - Country:US
Practice Address - Phone:480-751-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5110235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ129648Medicaid