Healthcare Provider Details

I. General information

NPI: 1275499527
Provider Name (Legal Business Name): REBECCA M BAGWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E RAY RD STE 131
GILBERT AZ
85296-4206
US

IV. Provider business mailing address

4623 W BUTLER DR
CHANDLER AZ
85226-4811
US

V. Phone/Fax

Practice location:
  • Phone: 602-345-1515
  • Fax:
Mailing address:
  • Phone: 815-355-8782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: