| Growing Edges Llc | |
|
20779 W San Miguel Ave Buckeye AZ 85396-4609 | |
| (602) 980-9313 | |
| (602) 548-1446 |
| Full Name | Growing Edges Llc |
|---|---|
| Speciality | Psychologist |
| Location | 20779 W San Miguel Ave, Buckeye, Arizona |
| Authorized Official Name and Position | Ilyssa Swartout (PRESIDENT) |
| Authorized Official Contact | 6029809313 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Growing Edges Llc 19580 W Indian School Rd Ste 105-134 Buckeye AZ 85396-2081 Ph: (602) 548-1444 | Growing Edges Llc 20779 W San Miguel Ave Buckeye AZ 85396-4609 Ph: (602) 980-9313 |
| NPI Number | 1073739660 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 04/09/2025 |
| Certification Date | 04/09/2025 |
| Medicare PECOS PAC ID | 6103818208 |
|---|---|
| Medicare Enrollment ID | O20040331000033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073739660 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ilyssa P Swartout |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881630325 PECOS PAC ID: 5991797094 Enrollment ID: I20040414001195 |
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