Individual provider Active NPI

Lisa Dawn Bunker, MS, CCC-SLP

  • Speech-Language Pathologist
  • Glendale, AZ
National Provider Identifier
1831567197
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP14726 Issued in AZ
Practice address
19389 N 59TH Ave
Glendale, AZ 85308-6500
Phone
(623) 537-6000
Fax
(623) 537-6014
NPI assigned
Sep 3, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 7204397-4102 UT
Speech-Language Pathologist 235Z00000X SLP14726 AZ Primary

Addresses

Primary practice location

19389 N 59TH Ave
Glendale, AZ 85308-6500

Mailing address

19389 N 59TH Ave
Glendale, AZ 85308-6500
Phone (623) 537-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231215002861 AZ Practitioner - Qualified Speech Language Pathologist 8224487210 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwestern UniversityGroup PAC ID 6305734773, 116 clinicians

Practice addresses (Care Compare)

5815 W Utopia Rd
Glendale, AZ 85308-5251
Phone (623) 537-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
SLP14726AZMDSpeech-Language Pathologist
7204397-4102UTMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Midwestern University CurrentSince Oct 28, 2023 Accepting new patients
Midwestern University CurrentSince Oct 28, 2023 Accepting new patients

Locations

19389 N 59th Ave
Glendale, AZ 85308

5815 W Utopia Rd
Glendale, AZ 85308
Phone (623) 806-7797

26520 Network Pl
Chicago, IL 60673
Phone (630) 743-4500

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1441238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1831567197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19389 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086500",
            "telephone_number": "623-537-6000",
            "fax_number": "623-537-6014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19389 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086500",
            "telephone_number": "623-537-6000",
            "fax_number": "623-537-6014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNKER",
        "first_name": "LISA",
        "middle_name": "DAWN",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-03",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "UT",
            "license": "7204397-4102",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "SLP14726",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.