Provider Demographics
NPI:1053929877
Name:MAGID, JENNAH ALEXIS (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNAH
Middle Name:ALEXIS
Last Name:MAGID
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 E UNIVERSITY DR APT 348
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-8718
Mailing Address - Country:US
Mailing Address - Phone:248-505-9127
Mailing Address - Fax:
Practice Address - Street 1:2112 CANTERWOOD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4237
Practice Address - Country:US
Practice Address - Phone:248-505-9127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty