Provider Demographics
NPI:1740539378
Name:NESVIK, JEANINE ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:ELIZABETH
Last Name:NESVIK
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 1:10631 S 51ST ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5225
Mailing Address - Country:US
Mailing Address - Phone:480-398-4820
Mailing Address - Fax:
Practice Address - Street 1:10631 S 51ST ST
Practice Address - Street 2:SUITE 8
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5225
Practice Address - Country:US
Practice Address - Phone:480-398-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP7490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12139307OtherAMERICAN SPEECH AND HEARING ASSOCIATION
AZTSLP7490OtherARIZONA DEPARTMENT OF HEALTH SERVICES