MEDICARE: KRISTEN GILBERT BS, RSST, QMRP

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	104100000X	Social Worker	L2393359	MI

General Provider Information

NPI Number	:	1891118733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN GILBERT BS, RSST, QMRP

Provider Business Mailing Address
First Line	:	31738 RUSH ST
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-1758
Country	:	US
Telephone Number	:	734-377-1753
Fax Number	:	734-427-3327

Provider Business Practice Location Address
First Line	:	31738 RUSH ST
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-1758
Country	:	US
Telephone Number	:	734-377-1753
Fax Number	:	734-427-3327

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

Provider Enumeration Date	:	01/29/2014
Last Update Date	:	02/18/2014

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