Healthcare Provider Details

I. General information

NPI: 1932039385
Provider Name (Legal Business Name): JENNA JAWAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18635 N 35TH AVE STE 106
PHOENIX AZ
85027-6182
US

IV. Provider business mailing address

4532 E DUANE LN
CAVE CREEK AZ
85331-6262
US

V. Phone/Fax

Practice location:
  • Phone: 602-488-5526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA16276
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: