Healthcare Provider Details

I. General information

NPI: 1366068199
Provider Name (Legal Business Name): JENNIFER SALISBURY BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W PINNACLE PEAK RD STE 170
PHOENIX AZ
85027-1224
US

IV. Provider business mailing address

2222 W PINNACLE PEAK RD STE 170
PHOENIX AZ
85027-1224
US

V. Phone/Fax

Practice location:
  • Phone: 623-582-6699
  • Fax:
Mailing address:
  • Phone: 623-582-6699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD1673
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: