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NPI Code Detail

MEDICARE: JESSICA WAECHTER CCC-SLP

MEDICARE: JESSICA WAECHTER 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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1770339087
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA WAECHTER CCC-SLP
Provider Business Mailing Address
First Line : 2301 E YEAGER DR STE 14
Second Line :
City : CHANDLER
State : AZ
Zip : 85286-1578
Country : US
Telephone Number : 602-606-2237
Fax Number : 844-475-2307
Provider Business Practice Location Address
First Line : 15220 S 50TH ST STE 103
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-9132
Country : US
Telephone Number : 480-795-7165
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2024
Last Update Date : 04/26/2024

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Directions to “ JESSICA WAECHTER CCC-SLP” Practice Location

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