Healthcare Provider Details

I. General information

NPI: 1982770483
Provider Name (Legal Business Name): ZETA ELIZABETH HITCHCOCK SCHOOL PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15002 N 32 STREET
PHOENIX AZ
85020
US

IV. Provider business mailing address

15002 N 32 STREET
PHOENIX AZ
85032
US

V. Phone/Fax

Practice location:
  • Phone: 602-493-6440
  • Fax:
Mailing address:
  • Phone: 602-867-5223
  • 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: