MEDICARE: MARIANNE KAY FLAK

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1255510897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE KAY FLAK

Provider Business Mailing Address
First Line	:	3450 BROAD ST
Second Line	:	SUITE 104
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7214
Country	:	US
Telephone Number	:	805-597-4970
Fax Number	:	805-549-8973

Provider Business Practice Location Address
First Line	:	3450 BROAD ST
Second Line	:	SUITE 104
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7214
Country	:	US
Telephone Number	:	805-597-4970
Fax Number	:	805-549-8973

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	10/31/2007

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