Healthcare Provider Details

I. General information

NPI: 1083538300
Provider Name (Legal Business Name): OLIVIA FERGUSON ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29697 N DESERT WILLOW BLVD
SAN TAN VALLEY AZ
85143-3917
US

IV. Provider business mailing address

1000 S. MAIN ST. PO BOX 2850 ATTN. WALKER BUTTE MIDDLE SCHOOL
FLORENCE AZ
85132
US

V. Phone/Fax

Practice location:
  • Phone: 480-987-5360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number5748558
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: