Provider Demographics
NPI:1669660619
Name:HERRERA, JESSICA ANN SCHAUER (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN SCHAUER
Last Name:HERRERA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:SCHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505-0029
Mailing Address - Country:US
Mailing Address - Phone:928-755-3404
Mailing Address - Fax:
Practice Address - Street 1:294 W CARLOS AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025-1846
Practice Address - Country:US
Practice Address - Phone:928-755-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE4441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP5646OtherAZ STATE
CARPE4441OtherCALIFORNIA SLAB