Healthcare Provider Details

I. General information

NPI: 1194807446
Provider Name (Legal Business Name): DR. ROBERT SCOTT KURKLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15002 N 32ND ST
PHOENIX AZ
85032-4441
US

IV. Provider business mailing address

15002 N 32ND ST
PHOENIX AZ
85032-4441
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-5223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number010210-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: