Individual
GRACE MCKONE SHIVKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3042 W QUEEN CREEK RD, CHANDLER, AZ 85248-2815
(602) 528-1200
Mailing address
PO BOX 38, SACATON, AZ 85147-0001
(602) 528-1200
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-18192
AZ
Other
Enumeration date
05/13/2020
Last updated
05/13/2020
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