Mendocino Nicole Peacock Adzagah, MS

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

CF7205 Issued in NM

Practice address

5770 S Fashion Boulevard
Building 5 Suite 210
Murray, UT 84107

Phone

(833) 577-3422

NPI assigned

May 21, 2021

Last updated

Oct 18, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mendy Adzagah Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1891360970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5770 S FASHION BLVD",
            "address_2": "BLDG #5, SUITE 210",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841076330",
            "telephone_number": "801-314-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5770 S FASHION BOULEVARD",
            "address_2": "BUILDING 5 SUITE 210",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "84107",
            "telephone_number": "833-577-3422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADZAGAH",
        "first_name": "MENDOCINO",
        "middle_name": "NICOLE PEACOCK",
        "credential": "MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-21",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NM",
            "license": "CF7205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": ".",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": ".",
            "affiliation": "N",
            "address_1": "5770 S Fashion Boulevard",
            "address_2": "Building 5 Suite 210",
            "city": "Murray",
            "state": "UT",
            "country_code": "US",
            "postal_code": "84107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MENDY",
            "last_name": "ADZAGAH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Speech-Language Pathologist in Murray, UT
• Providers in Murray, UT by specialty
• Speech-Language Pathologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; 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.