MEDICARE: MS. CHRISTINE LOUISE LANDIS LCSW

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	22066	CA

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

General Provider Information

NPI Number	:	1477643781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE LOUISE LANDIS LCSW

Provider Business Mailing Address
First Line	:	1100 W SHAW AVE
Second Line	:	SUITE 112
City	:	FRESNO
State	:	CA
Zip	:	93711-3708
Country	:	US
Telephone Number	:	559-221-8874
Fax Number	:	559-222-5789

Provider Business Practice Location Address
First Line	:	1100 W SHAW AVE
Second Line	:	SUITE 112
City	:	FRESNO
State	:	CA
Zip	:	93711-3708
Country	:	US
Telephone Number	:	559-221-8874
Fax Number	:	559-222-5789

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

Provider Enumeration Date	:	10/15/2006
Last Update Date	:	09/16/2008

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