MEDICARE: TIFFANY KENSLOW 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	L4788	OR

General Provider Information

NPI Number	:	1255649141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY KENSLOW MSW

Provider Business Mailing Address
First Line	:	508 WASHINGTON ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-2232
Country	:	US
Telephone Number	:	541-386-2337
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 WASHINGTON ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-2232
Country	:	US
Telephone Number	:	541-386-2337
Fax Number	:

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

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	02/28/2011

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