Healthcare Provider Details

I. General information

NPI: 1255261848
Provider Name (Legal Business Name): DYMPHNA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 E SHEA BLVD STE 167
PHOENIX AZ
85028-3367
US

IV. Provider business mailing address

3420 E SHEA BLVD STE 167
PHOENIX AZ
85028-3367
US

V. Phone/Fax

Practice location:
  • Phone: 602-449-0614
  • Fax: 602-584-6259
Mailing address:
  • Phone: 602-449-0614
  • Fax: 602-584-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. JILLIAN MARIE CALDWELL
Title or Position: OWNER
Credential: LCSW
Phone: 602-449-0614