Healthcare Provider Details

I. General information

NPI: 1316648322
Provider Name (Legal Business Name): JODI LEE OHNICK LCHW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S ASH AVE
TEMPE AZ
85281-2812
US

IV. Provider business mailing address

1620 N 61ST DR
PHOENIX AZ
85035-4804
US

V. Phone/Fax

Practice location:
  • Phone: 480-350-8004
  • Fax:
Mailing address:
  • Phone: 602-373-0463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW0000000022
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: