Healthcare Provider Details

I. General information

NPI: 1356351415
Provider Name (Legal Business Name): RAKEESHA R REEVES M.A., CFY-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9261 W VAN BUREN ST
TOLLESON AZ
85353-2941
US

IV. Provider business mailing address

11875 W MCDOWELL RD APT 1153
AVONDALE AZ
85323-3104
US

V. Phone/Fax

Practice location:
  • Phone: 623-907-5270
  • Fax: 623-907-5271
Mailing address:
  • Phone: 623-455-9261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: