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General NPI Number Information
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NPI Number | 1285386144
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Entity Type | Individual
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Provider Name | REBECCA J WANN
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Gender | Female
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Dates
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Enumeration Date | 01/21/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 3317 S HIGLEY RD STE 114-150
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City | GILBERT
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State | AZ
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Zip | 85297-5442
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Country | US
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Telephone | 801-302-7852
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Fax |
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Provider Business Mailing Address
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Address Line | 3553 E SEBASTIAN LN
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City | GILBERT
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State | AZ
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Zip | 85297-3060
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Country | US
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Telephone | 801-302-7852
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT-42727
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 9477248-3902
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT-15201
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License Number State | AZ
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