Individual
TIFFANY KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10142 W WATKINS ST, TOLLESON, AZ 85353-1289
(773) 627-1792
Mailing address
10142 W WATKINS ST, TOLLESON, AZ 85353-1289
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH5506
AZ
Other
Enumeration date
10/04/2018
Last updated
10/04/2018
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