Individual
STEPHANIE D KETNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4730 W SUNNYSIDE AVE, GLENDALE, AZ 85304-2927
(602) 413-0115
Mailing address
4730 W SUNNYSIDE AVE, GLENDALE, AZ 85304-2927
(602) 413-0115
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
2281564
AZ
Other
Enumeration date
01/25/2011
Last updated
01/25/2011
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