Healthcare Provider Details

I. General information

NPI: 1134247323
Provider Name (Legal Business Name): WILLIAM WALTER JENKINS PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15233 N 62ND PL
SCOTTSDALE AZ
85254-2505
US

IV. Provider business mailing address

15233 N 62ND PL
SCOTTSDALE AZ
85254-2505
US

V. Phone/Fax

Practice location:
  • Phone: 480-570-1140
  • Fax: 480-991-0174
Mailing address:
  • Phone: 480-570-1140
  • Fax: 480-991-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1154
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: