Healthcare Provider Details

I. General information

NPI: 1669338703
Provider Name (Legal Business Name): MELISSA CARMIENCKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1452 N HIGLEY RD
GILBERT AZ
85234-1610
US

IV. Provider business mailing address

2020 E WILDERMUTH AVE UNIT 2062
TEMPE AZ
85281-0369
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-0786
  • Fax:
Mailing address:
  • Phone: 602-516-6872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: