MEDICARE: MELISSA CARMIENCKE

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	106S00000X	Behavior Technician		AZ

General Provider Information

NPI Number	:	1669338703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA CARMIENCKE

Provider Business Mailing Address
First Line	:	2020 E WILDERMUTH AVE UNIT 2062
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-0369
Country	:	US
Telephone Number	:	602-516-6872
Fax Number	:

Provider Business Practice Location Address
First Line	:	1452 N HIGLEY RD
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-1610
Country	:	US
Telephone Number	:	480-269-0786
Fax Number	:

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

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/02/2026

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Directions to “ MELISSA CARMIENCKE ” Practice Location

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