Individual
JESSICA DETTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.,CCC-SLP
Contact information
Practice address
418 E MAIN ST, SPRINGERVILLE, AZ 85938-5220
(928) 333-6800
Mailing address
PO BOX 668, HOLBROOK, AZ 86025-0668
(928) 524-2123
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP12499
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14065279
ASHA
—
01
—
6138712
AZ DEPT OF ED
AZ
01
—
SLP12499
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
08/25/2015
Last updated
01/10/2023
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