Provider Demographics
NPI:1609973585
Name:THIEKING, GLENDA RAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:RAE
Last Name:THIEKING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8102 N 23RD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4962
Mailing Address - Country:US
Mailing Address - Phone:602-242-7383
Mailing Address - Fax:602-242-7387
Practice Address - Street 1:8102 N 23RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4962
Practice Address - Country:US
Practice Address - Phone:602-242-7383
Practice Address - Fax:602-242-7387
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3236103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical