Individual
KANESHA ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8910 W MONROE ST, PEORIA, AZ 85345-6440
(623) 248-4347
(623) 248-4355
Mailing address
12384 W HAZELWOOD ST, AVONDALE, AZ 85392-4275
(623) 418-5132
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH5607
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506836
—
AZ
Enumeration date
07/01/2019
Last updated
07/01/2019
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