Healthcare Provider Details

I. General information

NPI: 1043496227
Provider Name (Legal Business Name): MS. JENNIFER A. GUTHRIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 N 16TH ST
PHOENIX AZ
85016-2903
US

IV. Provider business mailing address

5601 N 16TH ST
PHOENIX AZ
85016-2903
US

V. Phone/Fax

Practice location:
  • Phone: 602-664-7927
  • Fax: 602-664-7998
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: