MEDICARE: AMY MICHELLE RODABAUGH 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	SLPA14455	AZ

General Provider Information

NPI Number	:	1942086178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MICHELLE RODABAUGH SLPA

Provider Business Mailing Address
First Line	:	4153 W SUNNYSIDE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3055
Country	:	US
Telephone Number	:	602-367-7565
Fax Number	:

Provider Business Practice Location Address
First Line	:	4153 W SUNNYSIDE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3055
Country	:	US
Telephone Number	:	602-367-7565
Fax Number	:

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

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	09/04/2023

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