Healthcare Provider Details

I. General information

NPI: 1235706623
Provider Name (Legal Business Name): ELIZABETH ANNE WEGLEY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2021
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W PEORIA AVE STE B301
PHOENIX AZ
85029-4618
US

IV. Provider business mailing address

3201 W PEORIA AVE STE B301
PHOENIX AZ
85029-4618
US

V. Phone/Fax

Practice location:
  • Phone: 602-291-9375
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-83571
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: