Healthcare Provider Details

I. General information

NPI: 1235043324
Provider Name (Legal Business Name): ELIZABETH RETTIG AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD STE F600
GLENDALE AZ
85306-4667
US

IV. Provider business mailing address

5750 W THUNDERBIRD RD STE F600
GLENDALE AZ
85306-4667
US

V. Phone/Fax

Practice location:
  • Phone: 602-863-4203
  • Fax:
Mailing address:
  • Phone: 602-863-4203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA17958
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: