Provider Demographics
NPI:1366940553
Name:BREWSTER, KALIE NICOLE
Entity type:Individual
Prefix:MS
First Name:KALIE
Middle Name:NICOLE
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALIE
Other - Middle Name:NICOLE
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3180 NEWBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1564
Mailing Address - Country:US
Mailing Address - Phone:408-640-6254
Mailing Address - Fax:
Practice Address - Street 1:3180 NEWBERRY DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1564
Practice Address - Country:US
Practice Address - Phone:408-640-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator