Provider Demographics
NPI:1417405226
Name:SWEEPE, TESSA
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:SWEEPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10208 W MARIPOSA GRANDE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2782
Mailing Address - Country:US
Mailing Address - Phone:602-448-8410
Mailing Address - Fax:
Practice Address - Street 1:10208 W MARIPOSA GRANDE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2782
Practice Address - Country:US
Practice Address - Phone:602-448-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW 34581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical