1053529073 NPI number — EXECUTIVE VOICE ENTERPRISES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053529073 NPI number — EXECUTIVE VOICE ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXECUTIVE VOICE ENTERPRISES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053529073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 S ALMA SCHOOL RD
Provider Second Line Business Mailing Address:
SUITE # C-107
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85210-3064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-777-2212
Provider Business Mailing Address Fax Number:
480-777-9092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 S ALMA SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE # C-107
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85210-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-777-2212
Provider Business Practice Location Address Fax Number:
480-777-9092
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
DARRELL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
SPEECH PATHOLOGIST
Authorized Official Telephone Number:
480-777-2212

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP0079 , 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)





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