Provider Demographics
NPI:1427700475
Name:MIRANDA, JACQUELINE YARIBEL
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:YARIBEL
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20239 W HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-9039
Mailing Address - Country:US
Mailing Address - Phone:602-626-0551
Mailing Address - Fax:
Practice Address - Street 1:20239 W HILTON AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-9039
Practice Address - Country:US
Practice Address - Phone:602-626-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ135772355S0801X
AZSLPA135772355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant