Provider Demographics
NPI:1376892026
Name:TABAREZ, JUANITA (MS)
Entity Type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:
Last Name:TABAREZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W HILLSIDE AVE
Mailing Address - Street 2:APT A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-7502
Mailing Address - Country:US
Mailing Address - Phone:928-533-9128
Mailing Address - Fax:
Practice Address - Street 1:212 W HILLSIDE AVE
Practice Address - Street 2:APT A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-7502
Practice Address - Country:US
Practice Address - Phone:928-533-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP7983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist