MEDICARE: KIM MAYFIELD SLPA

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	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1215303938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM MAYFIELD SLPA

Provider Business Mailing Address
First Line	:	1515 W BROOKS ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-2644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 E BASELINE RD STE 109
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4403
Country	:	US
Telephone Number	:	480-818-4212
Fax Number	:

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

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	06/09/2021

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Directions to “ KIM MAYFIELD SLPA” Practice Location

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