Healthcare Provider Details

I. General information

NPI: 1386313880
Provider Name (Legal Business Name): KARLA ALEXANDRA CALIX SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 N 36TH ST STE 125A
PHOENIX AZ
85018-3456
US

IV. Provider business mailing address

4545 N 36TH ST STE 125
PHOENIX AZ
85018-3456
US

V. Phone/Fax

Practice location:
  • Phone: 602-224-0202
  • Fax:
Mailing address:
  • Phone: 602-244-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA14149
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-184050
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: