MEDICARE: JESSICA MARIA SUAREZ M.A., CCC-SLP, TSSLD

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	031672	NY

General Provider Information

NPI Number	:	1689273948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIA SUAREZ M.A., CCC-SLP, TSSLD

Provider Business Mailing Address
First Line	:	6022 W OBERLIN WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-6501
Country	:	US
Telephone Number	:	917-244-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 W DUNLAP AVE STE 210
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5815
Country	:	US
Telephone Number	:	623-263-3966
Fax Number	:

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

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	05/25/2026

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