Healthcare Provider Details

I. General information

NPI: 1306103155
Provider Name (Legal Business Name): FLAGET SIMMS DUBE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4657 S LAKESHORE DR STE 1
TEMPE AZ
85282-7170
US

IV. Provider business mailing address

795 SAINT FRANCIS RD
SAINT FRANCIS KY
40062-7029
US

V. Phone/Fax

Practice location:
  • Phone: 502-648-5441
  • Fax:
Mailing address:
  • Phone: 502-648-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23962
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: