Provider Demographics
NPI:1548789415
Name:BREEDEN, PAIGE RICHELLE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:RICHELLE
Last Name:BREEDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23309 N 17TH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-6306
Mailing Address - Country:US
Mailing Address - Phone:602-882-4238
Mailing Address - Fax:480-867-0952
Practice Address - Street 1:23309 N 17TH DR STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-6306
Practice Address - Country:US
Practice Address - Phone:602-882-4238
Practice Address - Fax:480-867-0952
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-0296103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst