Provider Demographics
NPI:1467017269
Name:DIGIOSE, JACQUELINE (SLPA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DIGIOSE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:DIGIOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLPA
Mailing Address - Street 1:955 E KNOX RD UNIT 213
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1481
Mailing Address - Country:US
Mailing Address - Phone:480-369-4613
Mailing Address - Fax:
Practice Address - Street 1:4100 S LINDSAY RD STE 113
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1507
Practice Address - Country:US
Practice Address - Phone:480-219-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA117512355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant