Healthcare Provider Details

I. General information

NPI: 1427198332
Provider Name (Legal Business Name): SCOTT BUECHL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 N 44TH AVE
GLENDALE AZ
85301-4236
US

IV. Provider business mailing address

6530 N 44TH AVE
GLENDALE AZ
85301-4236
US

V. Phone/Fax

Practice location:
  • Phone: 623-842-0947
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: