MEDICARE: MR. SHON LAWRENCE TAMBLYN MSW

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	ASW17557	CA

General Provider Information

NPI Number	:	1235247065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHON LAWRENCE TAMBLYN MSW

Provider Business Mailing Address
First Line	:	4320 AUBURN BLVD STE 1200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-4153
Country	:	US
Telephone Number	:	916-418-0828
Fax Number	:	916-418-0838

Provider Business Practice Location Address
First Line	:	4320 AUBURN BLVD STE 1200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-4153
Country	:	US
Telephone Number	:	916-418-0828
Fax Number	:	916-418-0838

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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