=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023292216
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOVIA DARCELYN DOSSOU SPEECH PATHOLOGIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2007
-----------------------------------------------------
Last Update Date | 05/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 W VAN BUREN ST STE C
-----------------------------------------------------
City | AVONDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85323-1306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-505-6307
-----------------------------------------------------
Fax | 602-354-9408
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7425 W SOPHIE LN
-----------------------------------------------------
City | LAVEEN
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85339-3481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-622-2420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLPL 5552
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------