Provider Demographics
NPI:1609986660
Name:CAPLES, HEATHER S (PHD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:CAPLES
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 1:222 W THOMAS RD STE 315
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4422
Mailing Address - Country:US
Mailing Address - Phone:602-406-3671
Mailing Address - Fax:602-406-6115
Practice Address - Street 1:222 W THOMAS RD
Practice Address - Street 2:SUITE 315
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4419
Practice Address - Country:US
Practice Address - Phone:602-406-3671
Practice Address - Fax:602-406-6115
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3563103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ805963Medicaid
AZ77879Medicare ID - Type UnspecifiedMEDICARE #
AZ805963Medicaid