Provider Demographics
NPI:1801614086
Name:MENTAL SQUIRREL PLLC
Entity type:Organization
Organization Name:MENTAL SQUIRREL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATI
Authorized Official - Middle Name:
Authorized Official - Last Name:WIJDENES
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:480-418-0184
Mailing Address - Street 1:2747 E UNIVERSITY DR UNIT 31505
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85275-0270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2747 E UNIVERSITY DR UNIT 31505
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85275-0270
Practice Address - Country:US
Practice Address - Phone:480-418-0184
Practice Address - Fax:480-602-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty