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NPI Code Detail

MEDICARE: DR. ILYSSA SWARTOUT PSY.D.

MEDICARE:  DR. ILYSSA  SWARTOUT  PSY.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
1103TC0700XClinical Psychologist3612AZ

General Provider Information

NPI Number : 1881630325
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ILYSSA SWARTOUT PSY.D.
Provider Business Mailing Address
First Line : 19580 W INDIAN SCHOOL RD STE 105-134
Second Line :
City : BUCKEYE
State : AZ
Zip : 85396-2081
Country : US
Telephone Number : 602-548-1444
Fax Number : 602-548-1446
Provider Business Practice Location Address
First Line : 20779 W SAN MIGUEL AVE
Second Line :
City : BUCKEYE
State : AZ
Zip : 85396-4609
Country : US
Telephone Number : 602-980-9313
Fax Number : 602-548-1446
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 04/09/2025

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Directions to “ DR. ILYSSA SWARTOUT PSY.D.” Practice Location

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