Healthcare Provider Details

I. General information

NPI: 1144124926
Provider Name (Legal Business Name): EDITH GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S INDIAN BEND RD
TEMPE AZ
85288-4926
US

IV. Provider business mailing address

2505 W FREMONT DR
TEMPE AZ
85282-6205
US

V. Phone/Fax

Practice location:
  • Phone: 602-579-4833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17763
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: