Healthcare Provider Details

I. General information

NPI: 1770915985
Provider Name (Legal Business Name): JILL LARKIN ED.S., NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL SMEDLEY

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7747 W PIPESTONE PL
PHOENIX AZ
85035-5096
US

IV. Provider business mailing address

7747 W PIPESTONE PL
PHOENIX AZ
85035-5096
US

V. Phone/Fax

Practice location:
  • Phone: 801-920-8189
  • Fax:
Mailing address:
  • Phone: 801-920-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4584388
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: