Provider Demographics
NPI:1528756095
Name:BECKTOLD, VANESSA KATHERINE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:KATHERINE
Last Name:BECKTOLD
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 1:8215 W BELL RD STE 124
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3800
Mailing Address - Country:US
Mailing Address - Phone:623-933-0000
Mailing Address - Fax:
Practice Address - Street 1:8215 W BELL RD STE 124
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3800
Practice Address - Country:US
Practice Address - Phone:623-933-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD14405237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist