Provider Demographics
NPI:1033470778
Name:GADDIS, JUAWANA L
Entity Type:Individual
Prefix:MRS
First Name:JUAWANA
Middle Name:L
Last Name:GADDIS
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 1:888 E CLINTON ST
Mailing Address - Street 2:APT 1027
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5802
Mailing Address - Country:US
Mailing Address - Phone:480-382-2368
Mailing Address - Fax:
Practice Address - Street 1:888 E CLINTON ST
Practice Address - Street 2:APT 1027
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5802
Practice Address - Country:US
Practice Address - Phone:480-382-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant