Provider Demographics
NPI:1639846371
Name:HERRON, AUDRA (MAED)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 E SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-1564
Mailing Address - Country:US
Mailing Address - Phone:480-466-9939
Mailing Address - Fax:
Practice Address - Street 1:2310 E SPRUCE DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1564
Practice Address - Country:US
Practice Address - Phone:480-466-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-29
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool