MEDICARE: MS. ELIZABETH ANN KIRKENDALL MSW

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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1639322670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ANN KIRKENDALL MSW

Provider Business Mailing Address
First Line	:	725 LOMITA ST
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-3108
Country	:	US
Telephone Number	:	310-384-5076
Fax Number	:	310-322-6020

Provider Business Practice Location Address
First Line	:	725 LOMITA ST
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-3108
Country	:	US
Telephone Number	:	310-384-5076
Fax Number	:	310-322-6020

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

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	11/03/2008

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