Individual
JANESSA LYNN TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CF-SLP
Contact information
Practice address
13575 W MCDOWELL RD, GOODYEAR, AZ 85395-2604
(623) 536-9911
Mailing address
12376 W DEVONSHIRE AVE, AVONDALE, AZ 85392-4258
(417) 650-1146
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP12279
MO
Other
Enumeration date
02/27/2020
Last updated
02/27/2020
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