Provider Demographics
NPI:1417522244
Name:BODWELL, KATHY (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BODWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8043 S TALACO TRL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-8469
Mailing Address - Country:US
Mailing Address - Phone:323-600-4191
Mailing Address - Fax:
Practice Address - Street 1:4621 N 1ST AVE STE 8
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5655
Practice Address - Country:US
Practice Address - Phone:602-396-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-194051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty