MEDICARE: SOLEDAD KARDINSMITH

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

General Provider Information

NPI Number	:	1013396761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOLEDAD KARDINSMITH

Provider Business Mailing Address
First Line	:	115 FARABEE DR N
Second Line	:	SUITE C
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-5913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 FARABEE DR N
Second Line	:	SUITE C
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-5913
Country	:	US
Telephone Number	:	765-588-7763
Fax Number	:	765-423-5600

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

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	05/27/2015

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Directions to “ SOLEDAD KARDINSMITH ” Practice Location

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