Healthcare Provider Details

I. General information

NPI: 1023920451
Provider Name (Legal Business Name): CHANDLER BOSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 S COUNTRY CLUB DR
MESA AZ
85210-6809
US

IV. Provider business mailing address

PO BOX 50218
PHOENIX AZ
85076-0218
US

V. Phone/Fax

Practice location:
  • Phone: 480-398-4280
  • Fax:
Mailing address:
  • Phone: 480-398-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17927
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: