Provider Demographics
NPI:1285082057
Name:DELEON CHUMBLEY, DARITA ASHLEY
Entity type:Individual
Prefix:
First Name:DARITA
Middle Name:ASHLEY
Last Name:DELEON CHUMBLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22629 S VAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0257
Mailing Address - Country:US
Mailing Address - Phone:480-516-3733
Mailing Address - Fax:
Practice Address - Street 1:1405 N DOBSON RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8594
Practice Address - Country:US
Practice Address - Phone:480-299-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ100212355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant