MEDICARE: DR. KATHERINE SUSAN REARDEN LCSW, ACSW, BCD

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	1041C0700X	Clinical Social Worker	2593	LA

General Provider Information

NPI Number	:	1700863008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE SUSAN REARDEN LCSW, ACSW, BCD

Provider Business Mailing Address
First Line	:	4060 N FERNHILL CIR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-2414
Country	:	US
Telephone Number	:	520-298-8543
Fax Number	:	520-228-5283

Provider Business Practice Location Address
First Line	:	5380 E KACHINA ST
Second Line	:	DAVIS-MONTHAN AFB
City	:	TUCSON
State	:	AZ
Zip	:	85707-4923
Country	:	US
Telephone Number	:	520-228-4926
Fax Number	:	520-228-5283

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	07/08/2007

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