Healthcare Provider Details

I. General information

NPI: 1265366801
Provider Name (Legal Business Name): WENDY BOWERSOX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 E SHEA BLVD STE 101
PHOENIX AZ
85028-3346
US

IV. Provider business mailing address

700 W UNIVERSITY DR UNIT 123
TEMPE AZ
85281-3469
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-5474
  • Fax:
Mailing address:
  • Phone: 602-633-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW23863
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: