Healthcare Provider Details

I. General information

NPI: 1881413284
Provider Name (Legal Business Name): CALLIE O'CONNOR MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13980 N 67TH AVE STE 1
GLENDALE AZ
85306-3715
US

IV. Provider business mailing address

13980 N 67TH AVE STE 1
GLENDALE AZ
85306-3715
US

V. Phone/Fax

Practice location:
  • Phone: 623-755-9690
  • Fax:
Mailing address:
  • Phone: 623-755-9689
  • Fax: 623-264-3324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: