Provider Demographics
NPI:1376750182
Name:TSCHUPP, JACQUELINE MARY (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MARY
Last Name:TSCHUPP
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4332 W GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3618
Mailing Address - Country:US
Mailing Address - Phone:602-708-6321
Mailing Address - Fax:
Practice Address - Street 1:1016 N 32ND ST
Practice Address - Street 2:BLDG. B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-5107
Practice Address - Country:US
Practice Address - Phone:602-914-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist