MEDICARE: MS. MICHELLE R DEVOLL

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

General Provider Information

NPI Number	:	1386770089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE R DEVOLL

Provider Business Mailing Address
First Line	:	33215 MISSION BLVD APT B105
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-1451
Country	:	US
Telephone Number	:	510-475-6220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 PANAMA ST
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94545-4662
Country	:	US
Telephone Number	:	510-293-8539
Fax Number	:

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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