MEDICARE: DR. KATE AINSLIE PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	20455	CA

General Provider Information

NPI Number	:	1336324391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATE AINSLIE PSYD

Provider Business Mailing Address
First Line	:	864 S ROBERTSON BLVD
Second Line	:	SUITE 304
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1605
Country	:	US
Telephone Number	:	310-203-1316
Fax Number	:	310-861-1441

Provider Business Practice Location Address
First Line	:	864 S ROBERTSON BLVD
Second Line	:	SUITE 304
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1605
Country	:	US
Telephone Number	:	310-203-1316
Fax Number	:	310-861-1441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	01/08/2008

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