MEDICARE: JOSEFINA MARIE UNRUH CCC-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	SLP16817	AZ

General Provider Information

NPI Number	:	1306284708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEFINA MARIE UNRUH CCC-SLP

Provider Business Mailing Address
First Line	:	2128 E JEROME AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-6941
Country	:	US
Telephone Number	:	602-684-1378
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 S LINDSAY RD STE 113
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-1507
Country	:	US
Telephone Number	:	480-219-3953
Fax Number	:

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

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	04/24/2026

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