MEDICARE: CAILEY ELLA BROOKE FANTIN MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		AZ

General Provider Information

NPI Number	:	1073446720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAILEY ELLA BROOKE FANTIN MS

Provider Business Mailing Address
First Line	:	7450 W MONONA DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-9669
Country	:	US
Telephone Number	:	480-980-3557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 W ELLIOT RD STE 109
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-1310
Country	:	US
Telephone Number	:	480-374-4341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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