MEDICARE: RHONDA KIRKPATRICK

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	190768AP	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83-2030424	OTHER	CA	INSURANCE

General Provider Information

NPI Number	:	1033685144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA KIRKPATRICK

Provider Business Mailing Address
First Line	:	5336 WINNETKA AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-3551
Country	:	US
Telephone Number	:	818-857-9909
Fax Number	:

Provider Business Practice Location Address
First Line	:	5336 WINNETKA AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-3551
Country	:	US
Telephone Number	:	818-857-9909
Fax Number	:

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

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	10/16/2018

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Directions to “ RHONDA KIRKPATRICK ” Practice Location

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