Provider Demographics
NPI:1982016432
Name:KIZER, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KIZER
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 1:4250 E FLORIAN AVE
Mailing Address - Street 2:BUILDING #1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2797
Mailing Address - Country:US
Mailing Address - Phone:480-844-1653
Mailing Address - Fax:480-539-4947
Practice Address - Street 1:4250 E FLORIAN AVE
Practice Address - Street 2:BUILDING #1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2797
Practice Address - Country:US
Practice Address - Phone:480-844-1653
Practice Address - Fax:480-539-4947
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-13516101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor