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NPI Code Detail

MEDICARE: KATHRYN GRACE HEYDEN

MEDICARE: KATHRYN GRACE HEYDEN
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
1103K00000XBehavior AnalystBEH-000990AZ

General Provider Information

NPI Number : 1861118390
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN GRACE HEYDEN
Provider Business Mailing Address
First Line : 15220 S 50TH ST STE 103
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-9132
Country : US
Telephone Number : 480-868-6063
Fax Number :
Provider Business Practice Location Address
First Line : 15220 S 50TH ST STE 103
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-9132
Country : US
Telephone Number : 480-868-6063
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2022
Last Update Date : 10/17/2022

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Directions to “ KATHRYN GRACE HEYDEN ” Practice Location

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