Healthcare Provider Details

I. General information

NPI: 1790460608
Provider Name (Legal Business Name): KRISTEN CELESKI BHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN BRYANA CELESKI

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/15/2024
Certification Date: 06/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10209 W RIVERSIDE AVE
TOLLESON AZ
85353-8304
US

IV. Provider business mailing address

10209 W RIVERSIDE AVE
TOLLESON AZ
85353-8304
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-7399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: