MEDICARE: KATHRYN GLEASON

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW-16580	AZ

General Provider Information

NPI Number	:	1780125757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN GLEASON

Provider Business Mailing Address
First Line	:	3538 N AVENIDA ALBOR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-8822
Country	:	US
Telephone Number	:	503-560-5250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 E RIVER RD
Second Line	:	SUITE B140
City	:	TUCSON
State	:	AZ
Zip	:	85718-5877
Country	:	US
Telephone Number	:	503-560-5250
Fax Number	:

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

Provider Enumeration Date	:	03/10/2017
Last Update Date	:	03/10/2017

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