MEDICARE: VESNA KRIVOKUCA 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	PSY-005723	AZ

General Provider Information

NPI Number	:	1649917790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VESNA KRIVOKUCA PH.D.

Provider Business Mailing Address
First Line	:	9327 N 3RD ST STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2473
Country	:	US
Telephone Number	:	847-816-6335
Fax Number	:

Provider Business Practice Location Address
First Line	:	9327 N 3RD ST STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2473
Country	:	US
Telephone Number	:	847-816-6335
Fax Number	:	847-816-6335

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

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	01/13/2026

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