MEDICARE: JUDITH ELAINE KAJANDER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1341-1000	TX
2	1041C0700X	Clinical Social Worker	01159	TX

General Provider Information

NPI Number	:	1306175948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH ELAINE KAJANDER

Provider Business Mailing Address
First Line	:	2 WOODSTONE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-6228
Country	:	US
Telephone Number	:	713-560-6604
Fax Number	:	713-722-9185

Provider Business Practice Location Address
First Line	:	10190 KATY FWY STE 130
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-5245
Country	:	US
Telephone Number	:	713-647-0002
Fax Number	:

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

Provider Enumeration Date	:	12/10/2009
Last Update Date	:	12/10/2009

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