Healthcare Provider Details

I. General information

NPI: 1356925697
Provider Name (Legal Business Name): ALLISON THEABOLD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
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

1955 N JACKSON ST
CHANDLER AZ
85225-8412
US

V. Phone/Fax

Practice location:
  • Phone: 602-315-2401
  • Fax:
Mailing address:
  • Phone: 480-512-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA12967
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP17844
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: