Individual
LAURIE JATCZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CF-SLP
Contact information
Practice address
17100 E SHEA BLVD STE 600, FOUNTAIN HILLS, AZ 85268-6663
(480) 837-4565
Mailing address
9309 MONTEMAR DR, SPRING VALLEY, CA 91977-3419
(360) 969-6305
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP11868
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TSLP11868
ARIZONA DEPARTMENT OF HEALTH SERVICES
AZ
Enumeration date
06/29/2019
Last updated
06/29/2019
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