Provider Demographics
NPI:1760913578
Name:MORALES, JEANINE JEANNETTE
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:JEANNETTE
Last Name:MORALES
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 1:11026 N 28TH DR UNIT 23
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4337
Mailing Address - Country:US
Mailing Address - Phone:176-088-5079
Mailing Address - Fax:
Practice Address - Street 1:5750 W THUNDERBIRD RD BLDG E
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4669
Practice Address - Country:US
Practice Address - Phone:480-935-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP10491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist