Healthcare Provider Details

I. General information

NPI: 1598542045
Provider Name (Legal Business Name): KATIE ESPINOZA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 N SAND HILLS CT
CASA GRANDE AZ
85122-6664
US

IV. Provider business mailing address

2355 N SAND HILLS CT
CASA GRANDE AZ
85122-6664
US

V. Phone/Fax

Practice location:
  • Phone: 520-788-9455
  • Fax:
Mailing address:
  • Phone: 520-788-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-19898
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: