MEDICARE: MADELINE KETTLEWELL

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	:	1538692512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE KETTLEWELL

Provider Business Mailing Address
First Line	:	3419 VIA LIDO
Second Line	:	310
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-3908
Country	:	US
Telephone Number	:	949-723-2388
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 W BALBOA BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4527
Country	:	US
Telephone Number	:	949-723-2388
Fax Number	:	949-723-1288

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	04/06/2017

Similar Medicare Providers

1558657809 — OCEAN RECOVERY, LLC
Practice Location Address:

1601 W BALBOA BLVD
NEWPORT BEACH, CA
92663-4527

Practice Phone: 949-723-2388
Practice Fax: 949-723-1288

1386982650 — SAMANTHA OROSZ GRIMES LMFT
Practice Location Address:

1601 W BALBOA BLVD APT D
NEWPORT BEACH, CA
92663-4527

Practice Phone: 949-377-4886
Practice Fax:

1215468921 — MICHELLE CATHERINE BOUDREAUX
Practice Location Address:

1601 W BALBOA BLVD
NEWPORT BEACH, CA
92663-4527

Practice Phone: 949-723-2388
Practice Fax: 949-723-1288

1699206342 — KRISTINE ANGERER
Practice Location Address:

1601 W BALBOA BLVD
NEWPORT BEACH, CA
92663-4527

Practice Phone: 949-723-2388
Practice Fax:

1205367737 — MELISSA GRACE JACKSON
Practice Location Address:

1601 W BALBOA BLVD , APT D
NEWPORT BEACH, CA
92663-4527

Practice Phone: 949-723-2388
Practice Fax:

1306379250 — ANNA WERNER LVN
Practice Location Address:

1601 W BALBOA BLVD , APT D
NEWPORT BEACH, CA
92663-4527

Practice Phone: 949-723-2388
Practice Fax:

Directions to “ MADELINE KETTLEWELL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.