Provider Demographics
NPI:1740734458
Name:AGREDANO ELLIS, VERONICA (BS)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:AGREDANO ELLIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5384
Mailing Address - Street 2:1535 W CAMINO SECO
Mailing Address - City:ORACLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85623
Mailing Address - Country:US
Mailing Address - Phone:520-252-3820
Mailing Address - Fax:
Practice Address - Street 1:1115 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4228
Practice Address - Country:US
Practice Address - Phone:520-252-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical