Provider Demographics
NPI:1154902112
Name:GIDLEY, JOCELYN
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:GIDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:
Other - Last Name:DUBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6900 E PRINCESS DR UNIT 1230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4112
Mailing Address - Country:US
Mailing Address - Phone:520-272-3543
Mailing Address - Fax:
Practice Address - Street 1:4602 E UNIVERSITY DR STE 130
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-7430
Practice Address - Country:US
Practice Address - Phone:520-272-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-21-48505103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst