Healthcare Provider Details

I. General information

NPI: 1114849734
Provider Name (Legal Business Name): ISABELLE SHANNON OUELLETTE SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 E BASELINE RD STE 131
GILBERT AZ
85234-2690
US

IV. Provider business mailing address

7934 E LOMA LAND DR
SCOTTSDALE AZ
85257-3742
US

V. Phone/Fax

Practice location:
  • Phone: 602-510-1913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17714
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: