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1700903945 NPI number — GINA LESLIE WALTERS PH.D.

NPI Number: 1700903945
Health Care Provider/Practitioner: GINA LESLIE WALTERS PH.D.

Information about “1700903945” NPI (GINA LESLIE WALTERS PH.D.) exists in 1700903945 in HTML format HTML  |  1700903945 in plain Text format TXT  |  1700903945 in PDF (Portable Document Format) PDF  |  1700903945 in an XML format XML  formats.

NPI Number : 1700903945 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700903945",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALTERS",
    "FirstName": "GINA",
    "MiddleName": "LESLIE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "613 W SANDRA TER",
    "SecondLineMailingAddress": "613 W SANDRA TERR",
    "MailingAddressCityName": "PHOENIX",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85023-7409",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-298-2475",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "650 E INDIAN SCHOOL RD",
    "SecondLinePracticeLocationAddress": "PSYCHOLOGY DEPARTMENT 116B",
    "PracticeLocationAddressCityName": "PHOENIX",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85012-1839",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "602-277-5551",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/23/2007",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103G00000X",
          "TaxonomyName": "Clinical Neuropsychologist",
          "LicenseNumber": "3391",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "3391",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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