Healthcare Provider Details

I. General information

NPI: 1063765964
Provider Name (Legal Business Name): ALLISON SPENCER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON WALSH

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 08/18/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 E BASELINE RD STE 107
MESA AZ
85204-7287
US

IV. Provider business mailing address

3048 E BASELINE RD STE 107
MESA AZ
85204-7287
US

V. Phone/Fax

Practice location:
  • Phone: 480-482-1838
  • Fax:
Mailing address:
  • Phone: 480-482-1838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13703
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier749048
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: