Healthcare Provider Details

I. General information

NPI: 1578605424
Provider Name (Legal Business Name): WASHINGTON ELEMENTARY SCHOOL DISSTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SWEETWATER AVE
GLENDALE AZ
85304-1505
US

IV. Provider business mailing address

4650 W. SWEETWATER AVE.
GLENDALE AZ
85304-1505
US

V. Phone/Fax

Practice location:
  • Phone: 602-347-2653
  • Fax: 602-347-2709
Mailing address:
  • Phone: 602-347-2653
  • Fax: 602-347-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number557978
License Number StateAZ

VIII. Authorized Official

Name: MS. LORI J MORA
Title or Position: ASSISTANT SUPERINTENDENT
Credential:
Phone: 602-347-2605