Provider Demographics
NPI:1881729051
Name:LEGASPI, JEREMY JOSEPH (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:JOSEPH
Last Name:LEGASPI
Suffix:
Gender:M
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 1:6306 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1549
Mailing Address - Country:US
Mailing Address - Phone:602-279-5801
Mailing Address - Fax:
Practice Address - Street 1:6306 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1549
Practice Address - Country:US
Practice Address - Phone:602-279-5801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ970914Medicaid