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NPI Code Detail

MEDICARE: KATHERINE SPOHN STREETT

MEDICARE:   KATHERINE SPOHN STREETT
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
1101Y00000XCounselorLGP9183MD

General Provider Information

NPI Number : 1326518101
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE SPOHN STREETT
Provider Business Mailing Address
First Line : 764 BARGER DR
Second Line :
City : CROWNSVILLE
State : MD
Zip : 21032-1230
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1141 SUNRISE BEACH RD
Second Line :
City : CROWNSVILLE
State : MD
Zip : 21032-1126
Country : US
Telephone Number : 410-991-7663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2018
Last Update Date : 12/05/2018

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Directions to “ KATHERINE SPOHN STREETT ” Practice Location

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