MEDICARE: KATHLEEN SUE ROBERTS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1528233707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN SUE ROBERTS

Provider Business Mailing Address
First Line	:	6328 CHANNING DR
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-4344
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 TRIBUTE RD STE H
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4310
Country	:	US
Telephone Number	:	916-564-4400
Fax Number	:	916-564-4424

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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