Healthcare Provider Details

I. General information

NPI: 1871413070
Provider Name (Legal Business Name): PAIGE K GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W FRYE RD
CHANDLER AZ
85224-6178
US

IV. Provider business mailing address

1732 E SAN TAN ST
CHANDLER AZ
85225-8226
US

V. Phone/Fax

Practice location:
  • Phone: 480-812-7000
  • Fax:
Mailing address:
  • Phone: 480-358-7185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4959412
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: