=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366572273
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAY I. BUNNELL CODDINGTON L.C.S.W., A.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 07/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 S EL CAMINO REAL STE. 204
-----------------------------------------------------
City | SAN MATEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94402-1726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-872-0603
-----------------------------------------------------
Fax | 650-343-8244
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 S EL CAMINO REAL STE. 204
-----------------------------------------------------
City | SAN MATEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94402-1726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-872-0603
-----------------------------------------------------
Fax | 650-343-8244
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 7369
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------