Healthcare Provider Details

I. General information

NPI: 1720611494
Provider Name (Legal Business Name): ALISON LEIGH OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37200 N GANTZEL RD
SAN TAN VALLEY AZ
85140-7368
US

IV. Provider business mailing address

3310 E VALLEYHIGH TRL
SAN TAN VALLEY AZ
85143-1699
US

V. Phone/Fax

Practice location:
  • Phone: 520-342-0968
  • Fax:
Mailing address:
  • Phone: 928-279-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-002120
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: