Healthcare Provider Details

I. General information

NPI: 1477231793
Provider Name (Legal Business Name): MOLLY ANN BLOOMFIELD M.S., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date: 07/06/2026
Reactivation Date: 08/31/2026

III. Provider practice location address

415 N WESTWOOD
MESA AZ
85201-5530
US

IV. Provider business mailing address

13240 N 3RD WAY
PHOENIX AZ
85022-5245
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-4700
  • Fax:
Mailing address:
  • Phone: 480-310-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP17508
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: