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General NPI Number Information
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NPI Number | 1205468998
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Entity Type | Individual
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Provider Name | ALYSSA ANNE JORGENSEN SLP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 17100 E SHEA BLVD STE 600
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-6663
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Country | US
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Telephone | 480-837-4565
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Fax |
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Provider Business Mailing Address
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Address Line | 3691 E CONSTITUTION DR
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City | GILBERT
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State | AZ
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Zip | 85296-8243
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Country | US
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Telephone | 480-241-5520
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 11420368-4104
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License Number State | UT
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