Healthcare Provider Details

I. General information

NPI: 1851740948
Provider Name (Legal Business Name): LAKEISHA JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAKEISHA JOSEPH SLP

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21630 N 19TH AVE
PHOENIX AZ
85027-2719
US

IV. Provider business mailing address

1310 E SCORPIO PL
CHANDLER AZ
85249-2136
US

V. Phone/Fax

Practice location:
  • Phone: 602-875-5616
  • Fax:
Mailing address:
  • Phone: 678-618-0587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA10876
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPCET002216
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: