Healthcare Provider Details

I. General information

NPI: 1245362151
Provider Name (Legal Business Name): MS. ANN WEILER REEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAJO ROUTE 12 WINDOW ROCK SCHOOLS
FORT DEFIANCE AZ
86504-0559
US

IV. Provider business mailing address

PO BOX 378
FORT DEFIANCE AZ
86504-0378
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-6760
  • Fax: 928-729-6730
Mailing address:
  • Phone: 928-729-2374
  • Fax: 928-729-6730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number30643
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: