Provider Demographics
NPI:1013359348
Name:ANDERSON, JANE (SLPA6870)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:SLPA6870
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 W PRINCE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3014
Mailing Address - Country:US
Mailing Address - Phone:520-696-8856
Mailing Address - Fax:
Practice Address - Street 1:1450 W PRINCE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3014
Practice Address - Country:US
Practice Address - Phone:520-696-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA68702355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant