Provider Demographics
NPI:1649759119
Name:GAIN, JEAN CAROLINE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:CAROLINE
Last Name:GAIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 W SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1834
Mailing Address - Country:US
Mailing Address - Phone:602-885-3097
Mailing Address - Fax:
Practice Address - Street 1:4330 N 62ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1911
Practice Address - Country:US
Practice Address - Phone:480-484-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist