Provider Demographics
NPI:1063900025
Name:PICKERING, JANE ANN (HIS)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:PICKERING
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4838 E BASELINE RD STE 128B
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4673
Mailing Address - Country:US
Mailing Address - Phone:480-854-6774
Mailing Address - Fax:
Practice Address - Street 1:9925 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-8325
Practice Address - Country:US
Practice Address - Phone:480-825-6384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD1976237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist