Individual provider Active NPI

Victoria Adedayo Ajijedidun

  • Speech-Language Pathologist
  • Glendale, AZ
National Provider Identifier
1629453832
Registry record updated Jul 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
41YS00577100 Issued in NJ
Practice address
7301 N 58TH Ave
Glendale, AZ 85301-1893
Phone
(623) 237-7100
NPI assigned
Jul 29, 2015
Last updated
Jul 29, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 41YS00577100 NJ Primary

Addresses

Primary practice location

7301 N 58TH Ave
Glendale, AZ 85301-1893

Mailing address

7301 N 58TH Ave
Glendale, AZ 85301-1893

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191220001858 AZ Practitioner - Qualified Speech Language Pathologist 0345674537 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
41YS00577100NJMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Heartland Therapy, Inc. CurrentSince Nov 1, 2019 Accepting new patients
Theracare PLLC Speech-Language Pathologist CurrentSince Nov 1, 2019 Accepting new patients
Glendale Elementary School District #40 Past Accepting new patients

Locations

2830 E Brown Rd
Ste 1
Mesa, AZ 85213
Phone (480) 830-1188

530 E McDowell Rd
Ste 107475
Phoenix, AZ 85004

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1629453832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 N 58TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853011893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 N 58TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853011893",
            "telephone_number": "623-237-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AJIJEDIDUN",
        "first_name": "VICTORIA",
        "middle_name": "ADEDAYO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-29",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NJ",
            "license": "41YS00577100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.