MEDICARE: MARGARET SUDIMACK

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

General Provider Information

NPI Number	:	1124450630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET SUDIMACK

Provider Business Mailing Address
First Line	:	7020 W OCOTILLO RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-3124
Country	:	US
Telephone Number	:	978-453-8331
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 W SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85202-4716
Country	:	US
Telephone Number	:	623-888-3502
Fax Number	:

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

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	10/29/2021

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Directions to “ MARGARET SUDIMACK ” Practice Location

Language	Start Address	Practice Location

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