Healthcare Provider Details

I. General information

NPI: 1821321084
Provider Name (Legal Business Name): KIMBERLY CAOUETTE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 W THUNDERBIRD RD
GLENDALE AZ
85306-4900
US

IV. Provider business mailing address

PO BOX 168007
IRVING TX
75016-8007
US

V. Phone/Fax

Practice location:
  • Phone: 602-543-8019
  • Fax:
Mailing address:
  • Phone: 469-735-4545
  • Fax: 469-735-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3705
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: