Provider Demographics
NPI:1356391932
Name:SLOAN, KENNIE JO (LCSW)
Entity type:Individual
Prefix:
First Name:KENNIE
Middle Name:JO
Last Name:SLOAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KENNIE
Other - Middle Name:JO
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10237 N 66TH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1042
Mailing Address - Country:US
Mailing Address - Phone:602-277-5551
Mailing Address - Fax:602-212-2021
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:602-212-2021
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-108441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical