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NPI Code Detail

MEDICARE: KATIE WILLKOM

MEDICARE: KATIE WILLKOM
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1417467184
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE WILLKOM
Provider Business Mailing Address
First Line : 10425 PAINTER AVE
Second Line :
City : SANTA FE SPRINGS
State : CA
Zip : 90670-3429
Country : US
Telephone Number : 562-906-2685
Fax Number : 562-944-6713
Provider Business Practice Location Address
First Line : 10425 PAINTER AVE
Second Line :
City : SANTA FE SPRINGS
State : CA
Zip : 90670-3429
Country : US
Telephone Number : 562-906-2685
Fax Number : 562-944-6713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2017
Last Update Date : 10/06/2017

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Directions to “ KATIE WILLKOM ” Practice Location

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