MEDICARE: ANNE MARIE KLUDKA-GARZA MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	106H00000X	Marriage & Family Therapist
4	171M00000X	Case Manager/Care Coordinator
5	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1710645619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE MARIE KLUDKA-GARZA MS

Provider Business Mailing Address
First Line	:	8518 E INDIGO ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-3185
Country	:	US
Telephone Number	:	602-607-6408
Fax Number	:

Provider Business Practice Location Address
First Line	:	8518 E INDIGO ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-3185
Country	:	US
Telephone Number	:	602-607-6408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	06/09/2022

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