Healthcare Provider Details

I. General information

NPI: 1275460404
Provider Name (Legal Business Name): ALLIE GLEASON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1834 E BASELINE RD
TEMPE AZ
85283-1507
US

IV. Provider business mailing address

1020 E SPENCE AVE APT 1016
TEMPE AZ
85281-6832
US

V. Phone/Fax

Practice location:
  • Phone: 480-902-0771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: