Healthcare Provider Details

I. General information

NPI: 1083832703
Provider Name (Legal Business Name): SANDRA JOANN NEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA JOANN ISAAK

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21045 N 9TH PL STE 204
PHOENIX AZ
85024-5635
US

IV. Provider business mailing address

21045 N 9TH PL STE 204
PHOENIX AZ
85024-5635
US

V. Phone/Fax

Practice location:
  • Phone: 602-726-2300
  • Fax: 602-726-2322
Mailing address:
  • Phone: 602-726-2300
  • Fax: 602-726-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP14159
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 10923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: