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General NPI Number Information
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NPI Number | 1841374360
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Entity Type | Individual
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Provider Name | JEREMY TODD EHMKE ED.S., NCSP
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20740 S ELLSWORTH RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-9058
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Country | US
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Telephone | 480-987-5900
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Fax | 480-987-9714
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Provider Business Mailing Address
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Address Line | 19450 E REINS RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-8612
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Country | US
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Telephone | 480-987-0318
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 3671793
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License Number State | AZ
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