Healthcare Provider Details

I. General information

NPI: 1023774817
Provider Name (Legal Business Name): ASHLEY VAN BODEGON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 E ERICKSON DR
TUCSON AZ
85712-2822
US

IV. Provider business mailing address

6125 E INDIAN SCHOOL RD STE 1005
SCOTTSDALE AZ
85251-5469
US

V. Phone/Fax

Practice location:
  • Phone: 520-733-2250
  • Fax:
Mailing address:
  • Phone: 623-404-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: