Healthcare Provider Details

I. General information

NPI: 1235960428
Provider Name (Legal Business Name): KAMOGELO MOKEYANE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 N SCOTTSDALE RD STE 200
SCOTTSDALE AZ
85257-3429
US

IV. Provider business mailing address

1375 N SCOTTSDALE RD STE 200
SCOTTSDALE AZ
85257-3429
US

V. Phone/Fax

Practice location:
  • Phone: 404-553-2699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW18232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: