MEDICARE: KIM SPREWELL-WHITE

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	101Y00000X	Counselor	370069BN	CA

General Provider Information

NPI Number	:	1316073935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM SPREWELL-WHITE

Provider Business Mailing Address
First Line	:	1357 BROADWAY
Second Line	:	100
City	:	EL CAJON
State	:	CA
Zip	:	92021-5811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1357 BROADWAY
Second Line	:	100
City	:	EL CAJON
State	:	CA
Zip	:	92021-5811
Country	:	US
Telephone Number	:	619-588-1989
Fax Number	:	619-588-6282

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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Directions to “ KIM SPREWELL-WHITE ” Practice Location

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