Provider Demographics
NPI:1235010190
Name:WIESKAMP, KENNI DANIELLE
Entity type:Individual
Prefix:
First Name:KENNI
Middle Name:DANIELLE
Last Name:WIESKAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENNI
Other - Middle Name:
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14287 N 87TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3698
Mailing Address - Country:US
Mailing Address - Phone:480-937-1000
Mailing Address - Fax:
Practice Address - Street 1:41810 N VENTURE DR UNIT C120
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3172
Practice Address - Country:US
Practice Address - Phone:623-212-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-010109225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty