Organization
SIMPLY ROOTED SPEECH & WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER MAIN (ADMINISTRATOR, OWNER)
(480) 573-2262
Entity
Organization
Contact information
Practice address
1910 S STAPLEY DR STE 221, MESA, AZ 85204-6680
(480) 573-2262
(480) 573-2169
Mailing address
10144 E CINTRON DR, MESA, AZ 85212-9579
(480) 573-2262
(480) 573-2169
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
133V00000X
Registered Dietitian
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161344
—
AZ
Enumeration date
09/05/2022
Last updated
07/09/2024
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