Healthcare Provider Details

I. General information

NPI: 1689147860
Provider Name (Legal Business Name): MARLEE RENEE IMPERIALE M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7204 N 16TH ST
PHOENIX AZ
85020-5201
US

IV. Provider business mailing address

7204 N 16TH ST
PHOENIX AZ
85020-5201
US

V. Phone/Fax

Practice location:
  • Phone: 602-368-3282
  • Fax: 602-314-4175
Mailing address:
  • Phone: 602-368-3282
  • Fax: 602-314-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP13256
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: