MEDICARE: KRISTEN M MALDONADO LMSW

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	101YM0800X	Mental Health Counselor	7524	KS

General Provider Information

NPI Number	:	1134430689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN M MALDONADO LMSW

Provider Business Mailing Address
First Line	:	4331 SW MISTY HARBOR DR
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66610-1404
Country	:	US
Telephone Number	:	315-955-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	4331 SW MISTY HARBOR DR
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66610-1404
Country	:	US
Telephone Number	:	315-955-0793
Fax Number	:

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

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	06/30/2010

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