Individual
PROF. STACI BROADWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
3830 E VAN BUREN ST, PHOENIX, AZ 85008-6920
(602) 243-7277
(602) 286-0808
Mailing address
2702 N 3RD ST STE 4020, PHOENIX, AZ 85004-4608
(602) 323-3492
(602) 323-3399
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
017898
NY
103TC0700X
Clinical Psychologist
Primary
4519
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206766
—
AZ
Enumeration date
04/21/2009
Last updated
06/12/2024
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