Healthcare Provider Details

I. General information

NPI: 1912891771
Provider Name (Legal Business Name): GABRIELLA RENEE GEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 S HIGLEY RD
MESA AZ
85206-2148
US

IV. Provider business mailing address

478 W LEAH AVE
GILBERT AZ
85233-2033
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-9777
  • Fax:
Mailing address:
  • Phone: 480-268-5256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA14365
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: