Healthcare Provider Details

I. General information

NPI: 1710655469
Provider Name (Legal Business Name): EMILY CLAIRE GELANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 W INDIAN SCHOOL RD BLDG D
AVONDALE AZ
85392-9520
US

IV. Provider business mailing address

12725 W INDIAN SCHOOL RD BLDG D
AVONDALE AZ
85392-9520
US

V. Phone/Fax

Practice location:
  • Phone: 602-638-3300
  • Fax:
Mailing address:
  • Phone: 602-638-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001352
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: