Healthcare Provider Details

I. General information

NPI: 1669917852
Provider Name (Legal Business Name): JEFF POLLETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 S ALMA SCHOOL RD STE 145
MESA AZ
85210-3049
US

IV. Provider business mailing address

16822 S 32ND PL
PHOENIX AZ
85048-7809
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-8384
  • Fax:
Mailing address:
  • Phone: 480-338-6264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA10385
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: