Provider Demographics
NPI:1619380425
Name:FLUECKIGER, KALLIE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:KALLIE
Middle Name:
Last Name:FLUECKIGER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32744 N 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8087
Mailing Address - Country:US
Mailing Address - Phone:602-743-5112
Mailing Address - Fax:
Practice Address - Street 1:32744 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8087
Practice Address - Country:US
Practice Address - Phone:602-743-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional