Individual
JESSICA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1025 N COUNTRY CLUB DR, MESA, AZ 85201-3307
(480) 472-0500
Mailing address
1025 N COUNTRY CLUB DR, MESA, AZ 85201-3307
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLPL5445
AZ
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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