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General NPI Number Information
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NPI Number | 1386131597
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Entity Type | Individual
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Provider Name | MRS. JOANN SO
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Gender | Female
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 4309 E FLORIAN AVE
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City | MESA
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State | AZ
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Zip | 85206-2798
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Country | US
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Telephone | 909-380-4779
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Fax |
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Provider Business Mailing Address
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Address Line | 26011 REYNOLDS ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-3941
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Country | US
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Telephone | 909-380-4779
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLPA11085
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License Number State | AZ
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