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General NPI Number Information
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NPI Number | 1013681006
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Entity Type | Individual
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Provider Name | KATHERINE MARIE HANLON
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Gender | Female
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 17235 N 75TH AVE STE F100
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City | GLENDALE
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State | AZ
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Zip | 85308-0871
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Country | US
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Telephone | 480-641-1165
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Fax |
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Provider Business Mailing Address
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Address Line | 12081 WEST LISBON LN
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City | EL MIRAGE
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State | AZ
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Zip | 85335
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Country | US
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Telephone | 314-477-5105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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