Individual
JENNA SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
25615 N RANCH GATE RD, SCOTTSDALE, AZ 85255-2141
(970) 744-1069
Mailing address
3901 E MERCER LN, PHOENIX, AZ 85028-3437
(970) 744-1069
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP9512
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP9512
DEPARTMENT OF HEALTH SERVICES LICENSE
AZ
Enumeration date
07/06/2015
Last updated
05/08/2017
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