Provider Demographics
NPI:1356383723
Name:JESSEE, TINA J (AUD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:J
Last Name:JESSEE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W GUADALUPE RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3332
Mailing Address - Country:US
Mailing Address - Phone:480-497-0780
Mailing Address - Fax:480-497-0790
Practice Address - Street 1:201 W GUADALUPE RD
Practice Address - Street 2:SUITE 315
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3332
Practice Address - Country:US
Practice Address - Phone:480-497-0780
Practice Address - Fax:480-497-0790
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA0060237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDA0060OtherSTATE LICENSE
AZS63571Medicare UPIN
AZ69478Medicare ID - Type Unspecified