Individual
CHARLYN PONDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
235 E RAY RD APT 2035, CHANDLER, AZ 85225-3362
(480) 692-9136
Mailing address
235 E RAY RD APT 2035, CHANDLER, AZ 85225-3362
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
8091955
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8091955
AZ DEPT OF HEALTH SERVICES
AZ
Enumeration date
10/10/2019
Last updated
10/10/2019
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