Healthcare Provider Details

I. General information

NPI: 1942336284
Provider Name (Legal Business Name): KATHERINE THERESE VANCE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7444 N LA OESTA AVE
TUCSON AZ
85704-3159
US

IV. Provider business mailing address

7090 N. ORACLE ROAD #178 PMB138
TUCSON AZ
85704-4383
US

V. Phone/Fax

Practice location:
  • Phone: 520-444-2559
  • Fax: 520-575-1625
Mailing address:
  • Phone: 520-444-2559
  • Fax: 520-575-1625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1786
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: