Provider Demographics
NPI:1699066878
Name:CERIMELI, TASHA (SLP)
Entity type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:
Last Name:CERIMELI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 W CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-8566
Mailing Address - Country:US
Mailing Address - Phone:480-430-9751
Mailing Address - Fax:
Practice Address - Street 1:375 S COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-2101
Practice Address - Country:US
Practice Address - Phone:480-507-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA71952355S0801X
AZSLPL8134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant