Active NPI
Lisa Marie Gamble-Mickley
- Speech-Language Pathologist
- Gilbert, AZ
National Provider Identifier
1790963015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP5443
- Practice address
- 4193 E Reins Rd
Gilbert, AZ 85297-9552 - Phone
- (480) 201-2799
- NPI assigned
- Feb 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | SLP5443 | AZ | Primary |
Addresses
Primary practice location
4193 E Reins Rd
Gilbert, AZ 85297-9552
Mailing address
4193 E Reins Rd
Gilbert, AZ 85297-9552
Phone (480) 201-2799
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP5443 | AZ | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202428800000",
"number": "1790963015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4193 E REINS RD",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852979552",
"telephone_number": "480-201-2799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4193 E REINS RD",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852979552",
"telephone_number": "480-201-2799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAMBLE-MICKLEY",
"first_name": "LISA",
"middle_name": "MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-08",
"last_updated": "2008-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "SLP5443",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.