Healthcare Provider Details

I. General information

NPI: 1780411124
Provider Name (Legal Business Name): COPPER SKY ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 N 90TH PL STE 201
SCOTTSDALE AZ
85258-5067
US

IV. Provider business mailing address

13454 N STONE VIEW TRL
FOUNTAIN HILLS AZ
85268-3356
US

V. Phone/Fax

Practice location:
  • Phone: 602-930-2599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TARA SHAE BOYD
Title or Position: OWNER
Credential:
Phone: 602-930-2599