Healthcare Provider Details

I. General information

NPI: 1225753346
Provider Name (Legal Business Name): JACQUELINE P. PARKES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 E GUADALUPE RD STE 103
GILBERT AZ
85234-5116
US

IV. Provider business mailing address

4801 E MCDOWELL RD STE 250
PHOENIX AZ
85008-7725
US

V. Phone/Fax

Practice location:
  • Phone: 480-904-6818
  • Fax: 480-904-5181
Mailing address:
  • Phone: 602-464-9576
  • Fax: 480-428-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-20826
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: