Provider Demographics
NPI:1932230380
Name:KOOL, KATHLEEN LEE (LAC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LEE
Last Name:KOOL
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 1:15644 N 55TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1755
Mailing Address - Country:US
Mailing Address - Phone:971-708-4060
Mailing Address - Fax:
Practice Address - Street 1:5533 E BELL RD STE 116
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1256
Practice Address - Country:US
Practice Address - Phone:971-708-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist