Healthcare Provider Details

I. General information

NPI: 1750151908
Provider Name (Legal Business Name): STEPHANY GILLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 32ND ST
PHOENIX AZ
85008-6205
US

IV. Provider business mailing address

1100 N PRIEST DR APT 2046
CHANDLER AZ
85226-1022
US

V. Phone/Fax

Practice location:
  • Phone: 602-815-1792
  • Fax:
Mailing address:
  • Phone: 414-510-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-20674
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: