MEDICARE: ASHLEY FITZGERALD MSW

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	1041C0700X	Clinical Social Worker		AZ

General Provider Information

NPI Number	:	1538700976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY FITZGERALD MSW

Provider Business Mailing Address
First Line	:	612 S 108TH PL
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85208-7601
Country	:	US
Telephone Number	:	480-603-5565
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 E COTTON CENTER BLVD STE 250
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-4806
Country	:	US
Telephone Number	:	602-633-1828
Fax Number	:

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

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	10/07/2019

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