Provider Demographics
NPI:1629386289
Name:KOOL, STEFANIE MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:MARIE
Last Name:KOOL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 N 140TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2437
Mailing Address - Country:US
Mailing Address - Phone:623-536-7956
Mailing Address - Fax:
Practice Address - Street 1:2620 N 140TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2437
Practice Address - Country:US
Practice Address - Phone:623-536-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4140103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z196224OtherPTAN