Provider Demographics
NPI:1548446776
Name:MICKELSON, JUDITH ANN (AUD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:MICKELSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:WAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13949 W MEEKER BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4436
Mailing Address - Country:US
Mailing Address - Phone:623-975-1660
Mailing Address - Fax:623-975-1654
Practice Address - Street 1:13949 W MEEKER BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4436
Practice Address - Country:US
Practice Address - Phone:623-975-1660
Practice Address - Fax:623-975-1654
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA4649231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDA4649OtherDEPARTMENT OF HEALTH SERVICES