Healthcare Provider Details

I. General information

NPI: 1871610329
Provider Name (Legal Business Name): MADISON SCHOOL DISTRICT #38
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 E ROSE LN
PHOENIX AZ
85014-1600
US

IV. Provider business mailing address

5601 N 16TH ST
PHOENIX AZ
85016-2903
US

V. Phone/Fax

Practice location:
  • Phone: 602-664-7430
  • Fax:
Mailing address:
  • Phone: 602-664-7900
  • 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: CHRISTINE CRAIN
Title or Position: SCHOOL PSYCHOLOGIST
Credential: MS
Phone: 602-664-7430