Provider Demographics
NPI:1689435125
Name:MOUNTAIN, VANESSA JEAN
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:JEAN
Last Name:MOUNTAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11620 E SAHUARO DR APT 2048
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-3172
Mailing Address - Country:US
Mailing Address - Phone:623-236-0953
Mailing Address - Fax:
Practice Address - Street 1:11620 E SAHUARO DR APT 2048
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-3172
Practice Address - Country:US
Practice Address - Phone:623-236-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA149932355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty