Provider Demographics
NPI:1245554807
Name:GREENFIELD, JACQUELINE MICHELE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MICHELE
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 E CAVE CREEK RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331
Mailing Address - Country:US
Mailing Address - Phone:623-252-2037
Mailing Address - Fax:
Practice Address - Street 1:6501 E CAVE CREEK RD
Practice Address - Street 2:SUITE 6
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331
Practice Address - Country:US
Practice Address - Phone:623-252-2037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP6436235Z00000X
AZSLPA64362355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant