=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184262172
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ZEIGER PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2019
-----------------------------------------------------
Last Update Date | 10/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4175 S ALAMO AVE
-----------------------------------------------------
City | DAVIS MONTHAN AFB
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85707-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-228-4357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4175 S ALAMO DR 355 OMRS/SGXW
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-228-4357
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY60580608
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------