Active NPI
Elizabeth Persis Dormady, M.A.CCC-SLP
- Speech-Language Pathologist
- Mesa, AZ
National Provider Identifier
1194872176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 0517
- Practice address
- 1025 N Country Club Dr
Mesa, AZ 85201-3307 - Phone
- (480) 472-0727
- Fax
- (480) 472-0705
- NPI assigned
- Jan 4, 2007
- Last updated
- Feb 22, 2008
- 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 | 0517 | AZ | Primary |
Addresses
Primary practice location
1025 N Country Club Dr
Mesa, AZ 85201-3307
Mailing address
2208 N Almond
Mesa, AZ 85213-2232
Phone (480) 644-7850
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 580515 | Medicaid | AZ |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0517 | AZ | MD | Foot & Ankle Surgery Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203638400000",
"number": "1194872176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2208 N ALMOND",
"city": "MESA",
"state": "AZ",
"postal_code": "852132232",
"telephone_number": "480-644-7850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1025 N COUNTRY CLUB DR",
"city": "MESA",
"state": "AZ",
"postal_code": "852013307",
"telephone_number": "480-472-0727",
"fax_number": "480-472-0705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORMADY",
"first_name": "ELIZABETH",
"middle_name": "PERSIS",
"name_prefix": "Ms.",
"credential": "M.A.CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-04",
"last_updated": "2008-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "0517",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "580515",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.