MEDICARE: KAITLIN MARIE BUDANIW LPC

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	101YP2500X	Professional Counselor	PC012328	PA

General Provider Information

NPI Number	:	1598388381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN MARIE BUDANIW LPC

Provider Business Mailing Address
First Line	:	1190 OLD YORK RD STE AANDB
Second Line	:
City	:	WARMINSTER
State	:	PA
Zip	:	18974-2047
Country	:	US
Telephone Number	:	215-491-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1190 OLD YORK RD STE AANDB
Second Line	:
City	:	WARMINSTER
State	:	PA
Zip	:	18974-2047
Country	:	US
Telephone Number	:	215-491-9900
Fax Number	:

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

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	05/27/2020

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