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General NPI Number Information
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NPI Number | 1811708191
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Entity Type | Organization
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Legal Business Name | JUNIPER PATH PSYCHOLOGY
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 7975 N HAYDEN RD STE D241
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-3278
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Country | US
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Telephone | 602-492-2995
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Fax | 623-288-8017
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Provider Business Mailing Address
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Address Line | 15411 W WADDELL RD STE 102
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City | SURPRISE
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State | AZ
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Zip | 85379-5170
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Country | US
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Telephone | 602-492-2995
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Fax | 623-288-8017
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SHANNON LEAH HENDRICKSON
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Credential | PSYD
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Telephone | 602-492-2995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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