MEDICARE: KATHLEEN JUNE STALNAKER

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	:	1386847499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN JUNE STALNAKER

Provider Business Mailing Address
First Line	:	130 W VICTORIA ST
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90248-3523
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	814 3RD ST
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-5339
Country	:	US
Telephone Number	:	714-478-9351
Fax Number	:

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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