Healthcare Provider Details

I. General information

NPI: 1417357500
Provider Name (Legal Business Name): STEFANIE MATHIS MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 N 37TH AVE
PHOENIX AZ
85019-3206
US

IV. Provider business mailing address

5810 N 49TH AVE
GLENDALE AZ
85301-6222
US

V. Phone/Fax

Practice location:
  • Phone: 623-217-0033
  • Fax:
Mailing address:
  • Phone: 623-842-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP9028
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: