Provider Demographics
NPI:1073237558
Name:KWAN, ELIZABETH JOSEPHINE (MT-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOSEPHINE
Last Name:KWAN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13625 S 48TH ST APT 1136
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5052
Mailing Address - Country:US
Mailing Address - Phone:801-455-0488
Mailing Address - Fax:
Practice Address - Street 1:1305 S GILBERT RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4019
Practice Address - Country:US
Practice Address - Phone:801-455-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17046225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist