Provider Demographics
NPI:1053928648
Name:KIEDING, ELIZABETH SARAH
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SARAH
Last Name:KIEDING
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 1:4732 E CALLE ELEGANTE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3733
Mailing Address - Country:US
Mailing Address - Phone:520-307-5398
Mailing Address - Fax:
Practice Address - Street 1:4732 E CALLE ELEGANTE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-3733
Practice Address - Country:US
Practice Address - Phone:520-307-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-187351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical