Provider Demographics
NPI:1083885008
Name:JUVAN, JILL MARIE (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:JUVAN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E MCDOWELL RD STE LL1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2606
Mailing Address - Country:US
Mailing Address - Phone:602-956-1250
Mailing Address - Fax:623-321-8620
Practice Address - Street 1:1492 S MILL AVE STE 301
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5676
Practice Address - Country:US
Practice Address - Phone:602-956-1250
Practice Address - Fax:623-321-8620
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA5106231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ124598Medicaid