Individual
TERESA DOMRZALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1910 S STAPLEY DR STE 221, MESA, AZ 85204-6680
(480) 573-2662
(480) 573-2169
Mailing address
1179 E GOLDCREST ST, GILBERT, AZ 85297-3128
(480) 522-0388
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
SL23899
CA
235Z00000X
Speech-Language Pathologist
Primary
TSLP6794
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265153761
GROUP NPI
AZ
Enumeration date
08/23/2010
Last updated
07/09/2024
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