Provider Demographics
NPI:1902477599
Name:ENDRESON, EMILY JANE (MA, ATR-BC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
Last Name:ENDRESON
Suffix:
Gender:F
Credentials:MA, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 E ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1434
Mailing Address - Country:US
Mailing Address - Phone:520-815-8228
Mailing Address - Fax:
Practice Address - Street 1:84 W CUSHING ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-2218
Practice Address - Country:US
Practice Address - Phone:520-815-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist