Provider Demographics
NPI:1861107856
Name:ACOSTA, JO-ALI MILAN (SLPA)
Entity type:Individual
Prefix:
First Name:JO-ALI
Middle Name:MILAN
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6706
Mailing Address - Country:US
Mailing Address - Phone:915-244-2303
Mailing Address - Fax:
Practice Address - Street 1:6635 W HAPPY VALLEY RD STE A104-218
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-2609
Practice Address - Country:US
Practice Address - Phone:623-224-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA142742355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty