Provider Demographics
NPI:1871780619
Name:MAES, JERRETTA JOY (MA SLP)
Entity type:Individual
Prefix:MS
First Name:JERRETTA
Middle Name:JOY
Last Name:MAES
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8113 E SUNDEW DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-8575
Mailing Address - Country:US
Mailing Address - Phone:505-610-3993
Mailing Address - Fax:
Practice Address - Street 1:8113 E SUNDEW DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-8575
Practice Address - Country:US
Practice Address - Phone:505-610-3993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP-6239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist