Provider Demographics
NPI:1083262331
Name:SIMON, JOSEY (SLP)
Entity Type:Individual
Prefix:
First Name:JOSEY
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 N 24TH ST APT 243
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4676
Mailing Address - Country:US
Mailing Address - Phone:224-504-9153
Mailing Address - Fax:
Practice Address - Street 1:1333 N 24TH ST APT 243
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4676
Practice Address - Country:US
Practice Address - Phone:224-504-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP11158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist