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NPI Code Detail

MEDICARE: KRISTYNE SKIPPERGOSH ASW

MEDICARE: KRISTYNE SKIPPERGOSH ASW
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
1101YM0800XMental Health Counselor77865CA
2104100000XSocial Worker6801099324MI
31041C0700XClinical Social Worker90784CA

General Provider Information

NPI Number : 1932550407
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTYNE SKIPPERGOSH ASW
Provider Business Mailing Address
First Line : 995 GATEWAY CENTER WAY STE 300
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-4550
Country : US
Telephone Number : 619-398-2156
Fax Number :
Provider Business Practice Location Address
First Line : 5252 BALBOA AVE STE 800
Second Line :
City : SAN DIEGO
State : CA
Zip : 92117-6970
Country : US
Telephone Number : 619-404-0578
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2016
Last Update Date : 10/07/2022

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Directions to “ KRISTYNE SKIPPERGOSH ASW” Practice Location

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