Active NPI
Debra Kay Mikkelsen, MS CCC SLP
- Speech-Language Pathologist
- Tempe, AZ
National Provider Identifier
1003974775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP0239
- Practice address
- 625 W Cornell Dr
Tempe, AZ 85283 - Phone
- (480) 897-6233
- Fax
- (480) 838-0061
- NPI assigned
- Dec 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP0239 | AZ | Primary |
Addresses
Primary practice location
625 W Cornell Dr
Tempe, AZ 85283
Mailing address
3115 S Harl Ave
Tempe, AZ 85282
Phone (480) 221-9502
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP0239 | AZ | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003974775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3115 S HARL AVE",
"city": "TEMPE",
"state": "AZ",
"postal_code": "85282",
"telephone_number": "480-221-9502",
"fax_number": "480-838-0061"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 W CORNELL DR",
"city": "TEMPE",
"state": "AZ",
"postal_code": "85283",
"telephone_number": "480-897-6233",
"fax_number": "480-838-0061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKKELSEN",
"first_name": "DEBRA",
"middle_name": "KAY",
"name_prefix": "Ms.",
"credential": "MS CCC SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "SLP0239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tempe, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.