Individual
KYLE WACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
66 S 133RD ST, CHANDLER, AZ 85225-6014
(480) 204-6542
Mailing address
66 S 133RD ST, CHANDLER, AZ 85225-6014
(480) 204-6542
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
D08756225
AZ
Other
Enumeration date
05/31/2016
Last updated
05/31/2016
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