MEDICARE: MRS. KATHRYN CLIFTON

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	17906	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356565204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN CLIFTON

Provider Business Mailing Address
First Line	:	804 RIO GRANDE ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-2201
Country	:	US
Telephone Number	:	512-258-4579
Fax Number	:	512-322-9461

Provider Business Practice Location Address
First Line	:	1501 ENFIELD RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-3404
Country	:	US
Telephone Number	:	512-258-4579
Fax Number	:	512-322-9461

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/09/2007

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