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General NPI Number Information
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NPI Number | 1932701307
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Entity Type | Organization
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Legal Business Name | SONORAN NEUROPSYCHOLOGY PLLC
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 14300 N NORTHSIGHT BLVD STE 215
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-3677
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Country | US
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Telephone | 541-905-4763
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Fax |
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Provider Business Mailing Address
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Address Line | 8924 E PINNACLE PEAK RD STE G5-405
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-3618
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JESSICA POWELL
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Credential | PSYD
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Telephone | 541-905-4763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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