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General NPI Number Information
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NPI Number | 1861011041
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Entity Type | Individual
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Provider Name | NICOLE IVEY
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Gender | Female
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 8130 E CACTUS RD STE 510
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5263
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Country | US
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Telephone | 602-235-0566
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Fax |
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Provider Business Mailing Address
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Address Line | 1671 E GARY DR
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City | CHANDLER
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State | AZ
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Zip | 85225-1666
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Country | US
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Telephone | 480-226-0303
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | AZ
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