Provider Demographics
NPI:1538021522
Name:CHAMPAGNE, KAYDENCE AUDREY EVE
Entity type:Individual
Prefix:
First Name:KAYDENCE
Middle Name:AUDREY EVE
Last Name:CHAMPAGNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KADEN
Other - Middle Name:AUDREY EVE
Other - Last Name:CHAMPAGNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:629 N MESA DR APT 11
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5114
Mailing Address - Country:US
Mailing Address - Phone:331-274-8499
Mailing Address - Fax:
Practice Address - Street 1:629 N MESA DR APT 11
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5114
Practice Address - Country:US
Practice Address - Phone:331-274-8499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-27
Last Update Date:2025-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty