Healthcare Provider Details

I. General information

NPI: 1952581720
Provider Name (Legal Business Name): SARAH G. GRETHER EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAIL SCHOOL DISTRICT 13801 E. BENSON HWY.
VAIL AZ
85641
US

IV. Provider business mailing address

3088 S ELINORE DR
TUCSON AZ
85730-6125
US

V. Phone/Fax

Practice location:
  • Phone: 520-879-2000
  • Fax:
Mailing address:
  • Phone: 520-290-6294
  • 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: