Healthcare Provider Details

I. General information

NPI: 1689273948
Provider Name (Legal Business Name): JESSICA MARIA SUAREZ M.A., CCC-SLP, TSSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 W DUNLAP AVE STE 210
PHOENIX AZ
85021-5815
US

IV. Provider business mailing address

6022 W OBERLIN WAY
PHOENIX AZ
85083-6501
US

V. Phone/Fax

Practice location:
  • Phone: 623-263-3966
  • Fax:
Mailing address:
  • Phone: 917-244-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number031672
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: