Healthcare Provider Details

I. General information

NPI: 1801714860
Provider Name (Legal Business Name): ZOE IMANI AUSTIN SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 W ENCANTO BLVD
PHOENIX AZ
85035-2213
US

IV. Provider business mailing address

455 S RECKER RD APT 3135
GILBERT AZ
85296-0007
US

V. Phone/Fax

Practice location:
  • Phone: 602-442-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA16767
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: