Healthcare Provider Details

I. General information

NPI: 1104747088
Provider Name (Legal Business Name): KATHERINE C TESCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E FORT LOWELL RD STE 210
TUCSON AZ
85719-2366
US

IV. Provider business mailing address

3008 E 19TH ST
TUCSON AZ
85716-5751
US

V. Phone/Fax

Practice location:
  • Phone: 520-484-4879
  • Fax:
Mailing address:
  • Phone: 928-814-9637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-08449T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: