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NPI Code Detail

MEDICARE: JILL MARIE JUVAN M.S., CCC-A

MEDICARE: JILL MARIE JUVAN M.S., CCC-A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1231H00000XAudiologistDA5106AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083885008
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL MARIE JUVAN M.S., CCC-A
Provider Business Mailing Address
First Line : 1010 E MCDOWELL RD STE LL1
Second Line :
City : PHOENIX
State : AZ
Zip : 85006-2606
Country : US
Telephone Number : 602-956-1250
Fax Number : 623-321-8620
Provider Business Practice Location Address
First Line : 1492 S MILL AVE STE 301
Second Line :
City : TEMPE
State : AZ
Zip : 85281-5676
Country : US
Telephone Number : 602-956-1250
Fax Number : 623-321-8620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2008
Last Update Date : 08/14/2020

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