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General NPI Number Information
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NPI Number | 1073680195
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Entity Type | Individual
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Provider Name | MISS GWEN ELLEN MADDIX
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 3436 W MALAPAI
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City | PHX
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State | AZ
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Zip | 85051
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Country | US
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Telephone | 602-570-5742
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Fax |
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Provider Business Mailing Address
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Address Line | 4232 W WALTANN LN
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City | PHOENIX
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State | AZ
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Zip | 85053-3772
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Country | US
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Telephone | 602-570-5742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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