Provider Demographics
NPI:1053529073
Name:EXECUTIVE VOICE ENTERPRISES, LLC
Entity type:Organization
Organization Name:EXECUTIVE VOICE ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SP
Authorized Official - Phone:480-777-2212
Mailing Address - Street 1:1930 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE # C-107
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3064
Mailing Address - Country:US
Mailing Address - Phone:480-777-2212
Mailing Address - Fax:480-777-9092
Practice Address - Street 1:1930 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE # C-107
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3064
Practice Address - Country:US
Practice Address - Phone:480-777-2212
Practice Address - Fax:480-777-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty