Healthcare Provider Details

I. General information

NPI: 1801614086
Provider Name (Legal Business Name): MENTAL SQUIRREL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E WILLIAMS FIELD RD # 201-9
GILBERT AZ
85295-1823
US

IV. Provider business mailing address

1530 E WILLIAMS FIELD RD # 201-9
GILBERT AZ
85295-1823
US

V. Phone/Fax

Practice location:
  • Phone: 480-418-0184
  • Fax: 877-531-2934
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KATI WIJDENES
Title or Position: SOLE OWNER
Credential: DNP
Phone: 480-418-0184