Healthcare Provider Details

I. General information

NPI: 1407495591
Provider Name (Legal Business Name): JOHN VINCENT HERRERA SLPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 N 54TH PL
SCOTTSDALE AZ
85254-2369
US

IV. Provider business mailing address

21345 W ALVARADO RD
BUCKEYE AZ
85396-2522
US

V. Phone/Fax

Practice location:
  • Phone: 480-242-5903
  • Fax: 602-218-6462
Mailing address:
  • Phone: 623-225-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberSLPA12216
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA12216
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: