MEDICARE: STACEY CADIGAN KALINOWSKI M.A.

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	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8489	OTHER	CA	LPCC
2	0011708	OTHER	CO	LPC

General Provider Information

NPI Number	:	1982928206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY CADIGAN KALINOWSKI M.A.

Provider Business Mailing Address
First Line	:	5511 MARIT DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-3828
Country	:	US
Telephone Number	:	415-516-1642
Fax Number	:

Provider Business Practice Location Address
First Line	:	5511 MARIT DR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-3828
Country	:	US
Telephone Number	:	415-516-1642
Fax Number	:

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

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	09/05/2024

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