Healthcare Provider Details

I. General information

NPI: 1386146603
Provider Name (Legal Business Name): MS. SHAWNA KUHL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N LITCHFIELD RD STE 260
GOODYEAR AZ
85338-1369
US

IV. Provider business mailing address

2524 N STONE HILL RD
BUCKEYE AZ
85396-1682
US

V. Phone/Fax

Practice location:
  • Phone: 623-337-2275
  • Fax: 623-800-7626
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-22084
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: