Provider Demographics
NPI:1134384126
Name:EDUCATIONAL SUPPORT SPECIALISTS INC
Entity type:Organization
Organization Name:EDUCATIONAL SUPPORT SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:623-628-2789
Mailing Address - Street 1:7762 E GRAY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2966
Mailing Address - Country:US
Mailing Address - Phone:623-628-2789
Mailing Address - Fax:480-634-1935
Practice Address - Street 1:38632 N DONOVAN CT
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-2779
Practice Address - Country:US
Practice Address - Phone:623-628-2789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-19
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty