Healthcare Provider Details

I. General information

NPI: 1497678536
Provider Name (Legal Business Name): MS. JESSY HAUSER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15778 W YUMA RD
GOODYEAR AZ
85338-3358
US

IV. Provider business mailing address

15778 W YUMA RD
GOODYEAR AZ
85338-3358
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-7500
  • Fax:
Mailing address:
  • Phone: 623-932-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4594659
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: