Individual
KELLIE L CARDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BHT
Contact information
Practice address
6148 W FRIER DR, GLENDALE, AZ 85301-1223
(315) 955-0170
Mailing address
6148 W FRIER DR, GLENDALE, AZ 85301-1223
(315) 955-0170
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7777777
—
AZ
Enumeration date
10/26/2020
Last updated
10/26/2020
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