Provider Demographics
NPI:1659752863
Name:FAMILY FOCUS SPEECH THERAPY
Entity Type:Organization
Organization Name:FAMILY FOCUS SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOVIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DOSSOU
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:602-622-2420
Mailing Address - Street 1:7425 W SOPHIE LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-3481
Mailing Address - Country:US
Mailing Address - Phone:602-622-2420
Mailing Address - Fax:602-354-9408
Practice Address - Street 1:401 W VAN BUREN ST STE C
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1306
Practice Address - Country:US
Practice Address - Phone:623-505-6307
Practice Address - Fax:602-354-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1023292216Medicaid