MEDICARE: LEIGH IVES ED.S. NCSP

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	103TS0200X	School Psychologist		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	871477	OTHER	AZ	AHCCCS ID NUMBER

General Provider Information

NPI Number	:	1548313299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGH IVES ED.S. NCSP

Provider Business Mailing Address
First Line	:	15802 N PARKVIEW PL
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-7466
Country	:	US
Telephone Number	:	623-876-7198
Fax Number	:

Provider Business Practice Location Address
First Line	:	15802 N PARKVIEW PL
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374
Country	:	US
Telephone Number	:	623-876-7923
Fax Number	:

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	03/25/2026

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