Provider Demographics
NPI:1457734816
Name:JOSEPH, JENNIFER JOY (SLPA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOY
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 E LAKECREST DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2865
Mailing Address - Country:US
Mailing Address - Phone:310-721-2773
Mailing Address - Fax:
Practice Address - Street 1:2318 E LAKECREST DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2865
Practice Address - Country:US
Practice Address - Phone:310-721-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA88392355S0801X
AZSLPA 8839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist