Individual
MRS. MICHELLE LEIGH WANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15802 N PARKVIEW PL, SURPRISE, AZ 85374-7466
(623) 876-7000
Mailing address
12309 N 127TH LN, EL MIRAGE, AZ 85335-2204
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP5656
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
173181
AHCCCS PROVIDER ID
AZ
Enumeration date
09/28/2007
Last updated
09/28/2007
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