Healthcare Provider Details

I. General information

NPI: 1639918444
Provider Name (Legal Business Name): HOMEBODY SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3267 E TYSON ST
GILBERT AZ
85295-3429
US

IV. Provider business mailing address

3267 E TYSON ST
GILBERT AZ
85295-3429
US

V. Phone/Fax

Practice location:
  • Phone: 909-354-1975
  • Fax:
Mailing address:
  • Phone: 909-354-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXA TOMASELLI LEVY
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.A.CCC-SLP
Phone: 909-354-1975