Provider Demographics
NPI:1417251240
Name:WILEY, JENNIFER GAIL (MS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:GAIL
Last Name:WILEY
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 1:17100 E SHEA BLVD
Mailing Address - Street 2:SUITE #225
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6625
Mailing Address - Country:US
Mailing Address - Phone:480-837-4565
Mailing Address - Fax:888-957-8277
Practice Address - Street 1:17100 E SHEA BLVD
Practice Address - Street 2:SUITE #225
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6625
Practice Address - Country:US
Practice Address - Phone:480-837-4565
Practice Address - Fax:888-957-8277
Is Sole Proprietor?:No
Enumeration Date:2011-01-09
Last Update Date:2011-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist