Provider Demographics
NPI:1861531717
Name:HASKEW, KATHRYN ELIZABETH (MS, CAGS, NCSP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:HASKEW
Suffix:
Gender:F
Credentials:MS, CAGS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N ROOSEVELT AVE
Mailing Address - Street 2:UNIT 27
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2641
Mailing Address - Country:US
Mailing Address - Phone:620-740-5221
Mailing Address - Fax:
Practice Address - Street 1:2433 E ADOBE ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-6899
Practice Address - Country:US
Practice Address - Phone:480-472-2054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ805301Medicaid