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General NPI Number Information
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NPI Number | 1689746653
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Entity Type | Individual
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Provider Name | CYNTHIA A DODGE PHD
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 25827 N 122ND LN
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City | PEORIA
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State | AZ
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Zip | 85383-5814
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Country | US
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Telephone | 928-863-8431
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Fax |
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Provider Business Mailing Address
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Address Line | 30 COLINAS
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City | SEDONA
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State | AZ
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Zip | 86351-9238
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Country | US
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Telephone | 928-853-8269
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | LC4083
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License Number State | ME
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