Healthcare Provider Details

I. General information

NPI: 1598291403
Provider Name (Legal Business Name): ALLYSON WANDELL REID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 EAST CAMELBACK ROAD SUITE 600
PHOENIX AZ
85016
US

IV. Provider business mailing address

229 STEDMAN ST
LOWELL MA
01851-2705
US

V. Phone/Fax

Practice location:
  • Phone: 602-584-9860
  • Fax:
Mailing address:
  • Phone: 978-677-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-000360
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: