Provider Demographics
NPI:1538466271
Name:RANDLES, JOSIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:RANDLES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 E LA SALLE ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-9069
Mailing Address - Country:US
Mailing Address - Phone:206-351-8046
Mailing Address - Fax:
Practice Address - Street 1:15002 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4441
Practice Address - Country:US
Practice Address - Phone:602-449-2000
Practice Address - Fax:602-449-2245
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60043931235Z00000X
CA31789235Z00000X
AZSLP7146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ594097Medicaid