Individual provider Active NPI

Nicole A Kocanda, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Mesa, AZ
National Provider Identifier
1457053357
Registry record updated Oct 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
14382786 Issued in IL
Practice address
1025 N Country Club Dr
Mesa, AZ 85201-3302
Phone
(708) 979-1588
NPI assigned
Mar 22, 2023
Last updated
Oct 26, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 14382786 IL Primary

Addresses

Primary practice location

1025 N Country Club Dr
Mesa, AZ 85201-3302

Mailing address

7820 E Baseline Rd Unit 112
Mesa, AZ 85209-5438
Phone (708) 979-1588

Other practice location 1

11741 S Kedvale Ave
Alsip, IL 60803-1729
Phone (708) 979-1588

Other practice location 2

4100 Normal St
San Diego, CA 92103-2653
Phone (619) 725-8000

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

LicenseStateTypeSpecialty
14382786ILMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792972800000",
    "number": "1457053357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7820 E BASELINE RD UNIT 112",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852095438",
            "telephone_number": "708-979-1588"
        },
        {
            "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": "852013302",
            "telephone_number": "708-979-1588"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11741 S Kedvale Ave",
            "address_purpose": "LOCATION",
            "city": "Alsip",
            "state": "IL",
            "postal_code": "608031729",
            "country_code": "US",
            "telephone_number": "708-979-1588",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4100 Normal St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921032653",
            "country_code": "US",
            "telephone_number": "619-725-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOCANDA",
        "first_name": "NICOLE",
        "middle_name": "A",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-22",
        "last_updated": "2026-10-26",
        "certification_date": "2026-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "14382786",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.