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NPI Code Detail

MEDICARE: MRS. KRISTEN ANN JOHNSON-PHELPS SR. MS

MEDICARE: MRS. KRISTEN ANN JOHNSON-PHELPS SR. MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YS0200XSchool CounselorAZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1124375OTHERAZSCHOOL COUNSELOR

General Provider Information

NPI Number : 1356486427
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTEN ANN JOHNSON-PHELPS SR. MS
Provider Business Mailing Address
First Line : 9261 W VAN BUREN ST
Second Line :
City : TOLLESON
State : AZ
Zip : 85353-2941
Country : US
Telephone Number : 623-936-9740
Fax Number : 623-907-5187
Provider Business Practice Location Address
First Line : 9261 W VAN BUREN ST
Second Line :
City : TOLLESON
State : AZ
Zip : 85353-2941
Country : US
Telephone Number : 623-936-9740
Fax Number : 623-907-5187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2007
Last Update Date : 07/26/2007

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