MEDICARE: JOSEY SIMON SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP11158	AZ

General Provider Information

NPI Number	:	1083262331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEY SIMON SLP

Provider Business Mailing Address
First Line	:	1333 N 24TH ST APT 243
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4676
Country	:	US
Telephone Number	:	224-504-9153
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 N 24TH ST APT 243
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4676
Country	:	US
Telephone Number	:	224-504-9153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	08/29/2019

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Directions to “ JOSEY SIMON SLP” Practice Location

Language	Start Address	Practice Location

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