MEDICARE: DR. ROXANNE RUTH WITTE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	AZ1575	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0609640	OTHER	AZ	BCBS PREFERRED PROVIDER

General Provider Information

NPI Number	:	1376575787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROXANNE RUTH WITTE PH.D.

Provider Business Mailing Address
First Line	:	4721 W HATCHER RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3625
Country	:	US
Telephone Number	:	602-825-3741
Fax Number	:

Provider Business Practice Location Address
First Line	:	4721 W HATCHER RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-3625
Country	:	US
Telephone Number	:	602-825-3741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/26/2025

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