Healthcare Provider Details

I. General information

NPI: 1154038396
Provider Name (Legal Business Name): HEIDI PONCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NORTH STREET
SPRINGERVILLE AZ
85938
US

IV. Provider business mailing address

16115 W KENDALL ST
GOODYEAR AZ
85338-9465
US

V. Phone/Fax

Practice location:
  • Phone: 928-333-2683
  • Fax:
Mailing address:
  • Phone: 480-828-3941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW-23395
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: