Healthcare Provider Details

I. General information

NPI: 1427463884
Provider Name (Legal Business Name): ROCHELLE LE ROY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 E BROADWAY RD STE 1
TEMPE AZ
85282-1737
US

IV. Provider business mailing address

12600 N 113TH AVE BLDG A
YOUNGTOWN AZ
85363-1162
US

V. Phone/Fax

Practice location:
  • Phone: 480-525-0058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-22178
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA8647
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: