1356507719 NPI number — KRISTEN JOYCE JUNG M.S., CCC-SLP

Table of content: KRISTEN JOYCE JUNG M.S., CCC-SLP (NPI 1356507719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356507719 NPI number — KRISTEN JOYCE JUNG M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUNG
Provider First Name:
KRISTEN
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILMAN
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
JOYCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356507719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36205 W MARIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARICOPA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85238-2155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-205-5611
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2888 E BELLERIVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85298-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-327-8542
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  TSLP5591 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)