Provider Demographics
NPI:1184779100
Name:WEBBER, LINDA O (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:O
Last Name:WEBBER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:ELAINE
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2450 WEST PECOS ROAD
Mailing Address - Street 2:1011
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4834
Mailing Address - Country:US
Mailing Address - Phone:907-229-9205
Mailing Address - Fax:480-744-7603
Practice Address - Street 1:2450 WEST PECOS ROAD
Practice Address - Street 2:1011
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4834
Practice Address - Country:US
Practice Address - Phone:907-229-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA226103T00000X
AZPSY-005205103T00000X
CAPA6482103T00000X
AKPSYP226103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPS0226Medicaid
AKPS0226Medicaid