Provider Demographics
NPI:1467017269
Name:DIGIOSE, JACQUELINE (SLPA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DIGIOSE
Suffix:
Gender:
Credentials:SLPA
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:DIGIOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLPA
Mailing Address - Street 1:2625 E CAMELBACK RD APT 149
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4383
Mailing Address - Country:US
Mailing Address - Phone:480-369-4613
Mailing Address - Fax:
Practice Address - Street 1:1 W ELLIOT RD STE 109
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1310
Practice Address - Country:US
Practice Address - Phone:480-374-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA117512355S0801X
AZSLP11751235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant