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General NPI Number Information
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NPI Number | 1598125858
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Entity Type | Individual
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Provider Name | DOMINIQUE GIDDINGS
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Gender | Female
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 15672 W DEVONSHIRE AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-7773
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Country | US
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Telephone | 313-434-2723
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Fax | 520-350-1422
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Provider Business Mailing Address
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Address Line | 22621 N GIBSON DR
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City | MARICOPA
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State | AZ
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Zip | 85139-8840
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Country | US
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Telephone | 313-434-2723
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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