Basic Information
| Provider Information | |||||||||
| NPI: | 1487871034 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCIANDRA | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1441 N 12TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806845041 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1920 N HIGLEY RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852341623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805432688 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 08/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 3313 | AZ | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.