Healthcare Provider Details

I. General information

NPI: 1811812332
Provider Name (Legal Business Name): RAELEIGH NICHOLE TUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21728 E ROSA RD
QUEEN CREEK AZ
85142-4102
US

IV. Provider business mailing address

21728 E ROSA RD
QUEEN CREEK AZ
85142-4102
US

V. Phone/Fax

Practice location:
  • Phone: 480-845-4519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17810
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: