Healthcare Provider Details

I. General information

NPI: 1245554807
Provider Name (Legal Business Name): JACQUELINE MICHELE GREENFIELD M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 E CAVE CREEK RD SUITE 6
CAVE CREEK AZ
85331
US

IV. Provider business mailing address

6501 E CAVE CREEK RD SUITE 6
CAVE CREEK AZ
85331
US

V. Phone/Fax

Practice location:
  • Phone: 623-252-2037
  • Fax:
Mailing address:
  • Phone: 623-252-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA6436
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP6436
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: