MEDICARE: DR. MARY JOANNE HUETTEMAN PH.D.

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	103TC0700X	Clinical Psychologist	20640	CA

General Provider Information

NPI Number	:	1437161510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JOANNE HUETTEMAN PH.D.

Provider Business Mailing Address
First Line	:	2660 SOLACE PL STE B
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-4337
Country	:	US
Telephone Number	:	650-302-0159
Fax Number	:	650-306-9323

Provider Business Practice Location Address
First Line	:	2660 SOLACE PL STE B
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-4337
Country	:	US
Telephone Number	:	650-302-0159
Fax Number	:	650-306-9323

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	02/17/2016

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