Provider Demographics
NPI:1659947372
Name:DOWNING, WAYDE ALEXANDER
Entity Type:Individual
Prefix:
First Name:WAYDE
Middle Name:ALEXANDER
Last Name:DOWNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5656 S POWER RD STE 121
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8489
Mailing Address - Country:US
Mailing Address - Phone:480-482-5005
Mailing Address - Fax:
Practice Address - Street 1:5656 S POWER RD STE 121
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8489
Practice Address - Country:US
Practice Address - Phone:480-482-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZO23792401106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician