Healthcare Provider Details

I. General information

NPI: 1306284708
Provider Name (Legal Business Name): JOSEFINA MARIE UNRUH CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S LINDSAY RD STE 113
GILBERT AZ
85297-1507
US

IV. Provider business mailing address

2128 E JEROME AVE
MESA AZ
85204-6941
US

V. Phone/Fax

Practice location:
  • Phone: 480-219-3953
  • Fax:
Mailing address:
  • Phone: 602-684-1378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP16817
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: