Individual
KENNETH LEON HALE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4449 N 12TH ST, PHOENIX, AZ 85014-4520
(602) 279-1427
(602) 279-1431
Mailing address
PO BOX 16906, PHOENIX, AZ 85011-6906
(602) 279-1427
(602) 279-1431
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
9322593
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9322593
DCS/OLR LICENSING AUTHORITY
AZ
Enumeration date
06/13/2018
Last updated
06/13/2018
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