Individual
MRS. KATHLEEN ANN CHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4577 W PECOS RD, LAVEEN, AZ 85339
(520) 550-6041
(520) 550-6033
Mailing address
4577 W PECOS RD, LAVEEN, AZ 85339
(520) 550-6041
(520) 550-6033
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-3864
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
346214
—
AZ
Enumeration date
07/17/2009
Last updated
07/17/2009
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