Healthcare Provider Details

I. General information

NPI: 1558937110
Provider Name (Legal Business Name): KONNOR LEMONS CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 E WARNER RD STE 105
GILBERT AZ
85296-3055
US

IV. Provider business mailing address

690 E WARNER RD STE 105
GILBERT AZ
85296-3055
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-6366
  • Fax:
Mailing address:
  • Phone: 480-271-8041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP16948
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: