Healthcare Provider Details

I. General information

NPI: 1295853638
Provider Name (Legal Business Name): SANDRA SAMUELSON THOMPSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13801 E BENSON HWY
VAIL AZ
85641-9074
US

IV. Provider business mailing address

13801 E BENSON HWY P.O. BOX 800
VAIL AZ
85641-9074
US

V. Phone/Fax

Practice location:
  • Phone: 520-879-2061
  • Fax:
Mailing address:
  • Phone: 520-879-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: