Healthcare Provider Details

I. General information

NPI: 1790604361
Provider Name (Legal Business Name): KATHERINE KOEHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W NORTHERN AVE
PHOENIX AZ
85021-5157
US

IV. Provider business mailing address

911 E CAMELBACK RD UNIT 3088
PHOENIX AZ
85014-6128
US

V. Phone/Fax

Practice location:
  • Phone: 602-955-9059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW22216
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: