=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659752863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY FOCUS SPEECH THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2015
-----------------------------------------------------
Last Update Date | 05/18/2021
-----------------------------------------------------
=====================================================
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 | 602-354-9408
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MRS. JOVIA D DOSSOU
-----------------------------------------------------
Credential | M.S.,CCC-SLP
-----------------------------------------------------
Telephone | 602-622-2420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SLP5552
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------