MEDICARE: KATHLEEN BAUERNFREUND

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	101YP2500X	Professional Counselor		IL
2	101YP2500X	Professional Counselor	6467	CA

General Provider Information

NPI Number	:	1205109279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN BAUERNFREUND

Provider Business Mailing Address
First Line	:	55 SANTA CLARA AVE STE 170
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-1333
Country	:	US
Telephone Number	:	510-560-3675
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 SANTA CLARA AVE STE 170
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610-1333
Country	:	US
Telephone Number	:	510-560-3675
Fax Number	:

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

Provider Enumeration Date	:	02/21/2012
Last Update Date	:	11/21/2023

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