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General NPI Number Information
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NPI Number | 1619144029
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Entity Type | Organization
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Legal Business Name | JABBERJAWS PEDIATRIC SPEECH PATHOLOGY
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 501 S RANCHO DR STE. D-25
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City | LAS VEGAS
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State | NV
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Zip | 89106-4828
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Country | US
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Telephone | 702-898-5297
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Fax | 702-898-5298
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Provider Business Mailing Address
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Address Line | 501 S RANCHO DR STE. D-25
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City | LAS VEGAS
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State | NV
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Zip | 89106-4828
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Country | US
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Telephone | 702-898-5297
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Fax | 702-898-5298
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. JULIE ANNE COLE
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Credential | MA, CCC-SLP
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Telephone | 702-898-5297
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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 |
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License Number State |
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