| Doctor Name: | DR. JUDY ANN BANTA |
| NPI Number: | 1295957256 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ED.D. |
| License Number: | |
| Business Practice Address: | 98 South Skill Center Road Sacaton, AZ - 85247 |
| Business Phone Number: | 5205628600 |
| Business Fax Number: | 4807634440 |
| Mailing Address: | 601 West Linger Lane, PHOENIX |
| State: | AZ |
| Postal Code: | 85021 |
| Phone Number: | 5205628600 |
| Fax Number: | 4807634440 |
| NPI Enumeration Date: | 05/02/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |