Healthcare Provider Details

I. General information

NPI: 1063236701
Provider Name (Legal Business Name): ASHLEY B FELDKAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11851 N 51ST AVE STE F140
GLENDALE AZ
85304-2847
US

IV. Provider business mailing address

7500 N DREAMY DRAW DR STE 145
PHOENIX AZ
85020-4668
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4545
  • Fax: 623-242-1314
Mailing address:
  • Phone: 480-882-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW24005
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: