Healthcare Provider Details

I. General information

NPI: 1871401000
Provider Name (Legal Business Name): ELIESSE MARIE JAKOTICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 W GUADALUPE RD
GILBERT AZ
85233-3200
US

IV. Provider business mailing address

1233 S GILBERT RD
GILBERT AZ
85296-4106
US

V. Phone/Fax

Practice location:
  • Phone: 480-645-9310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: