Individual
HEATHER BRODERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
650 E INDIAN SCHOOL RD, MH&BSS 116A1, PHOENIX, AZ 85012-1839
(602) 277-5551
Mailing address
7319 W PARK ST, LAVEEN, AZ 85339-2646
(602) 315-4046
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54587
CTRS
—
Enumeration date
12/02/2010
Last updated
12/02/2010
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