Healthcare Provider Details

I. General information

NPI: 1699323956
Provider Name (Legal Business Name): KATIE ELIZABETH KEESE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14506 W GRANITE VALLEY DR STE 117
SUN CITY WEST AZ
85375-6011
US

IV. Provider business mailing address

13934 N 59TH AVE STE 120
GLENDALE AZ
85306-4168
US

V. Phone/Fax

Practice location:
  • Phone: 602-714-2709
  • Fax:
Mailing address:
  • Phone: 602-866-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA11943
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: