Healthcare Provider Details

I. General information

NPI: 1679027668
Provider Name (Legal Business Name): ANGELA KENZSLOWE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 N LITCHFIELD RD
LUKE AFB AZ
85309-1529
US

IV. Provider business mailing address

7860 E CAMELBACK RD UNIT 310
SCOTTSDALE AZ
85251-2262
US

V. Phone/Fax

Practice location:
  • Phone: 623-856-7579
  • Fax:
Mailing address:
  • Phone: 602-435-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4757
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: