Active NPI
Nicole Fountain
- Speech-Language Pathologist
- Phoenix, AZ
National Provider Identifier
1235748369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 25700 N. 21St Avenue
Phoenix, AZ 85085 - Phone
- (623) 445-5800
- NPI assigned
- Jul 24, 2020
- 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 | Primary |
Addresses
Primary practice location
25700 N. 21St Avenue
Phoenix, AZ 85085
Mailing address
1715 W Eagle Talon TRL
Phoenix, AZ 85085-5344
Phone (602) 309-1313
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595548800000",
"number": "1235748369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1715 W EAGLE TALON TRL",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850855344",
"telephone_number": "602-309-1313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25700 N. 21ST AVENUE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "85085",
"telephone_number": "623-445-5800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOUNTAIN",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-24",
"last_updated": "2020-07-24",
"certification_date": "2020-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
- Foundations for Change PLC
- Founders Healthcare, LLC (Preferred Homecare)
- Founders Healthcare, LLC (Preferred Homecare)
- Foundry Pediatric Behavioral Health LLC
- Fountain Home Health Inc
- Fountains Obstetrics & Gynecology, LTD
- Four Corners Counseling and Wellness Inc.
- Four Peaks Endodontics, LLC
- Four Peaks Medical Supply
- Four Seasons Medical Concierge LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.