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California Children Services Paneled Non PMF Provider Report
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Abbey Psychologist Psychology 11/08/2007Richard D
Abbott Physician Pediatrics 06/20/2005Lara
AbbottEPSDT Supplemental ServicesProvider Social Work 08/03/2004Yuko K
Abdelghani Physical Therapist Physical Therapy 05/08/2009Samer S
Abeles Speech Therapist Speech Language Pathology 02/09/2010Linda K
Abe-Woolridge Occupational Therapist Occupational Therapy 01/07/1979Sandra
AbriamEPSDT Supplemental ServicesProvider Social Work 04/06/2006Nerissa L
Page 1 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Abrisch Audiologist Audiology 02/14/2012Amanda
Achondo Occupational Therapist Occupational Therapy 04/10/2008Naomi Jaye A
AckermanEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/26/2012Ann
AcostaEPSDT Supplemental ServicesProvider Social Work 06/01/1975Alicia M
Adam Occupational Therapist Occupational Therapy 10/17/2006Ryan G
AdamsEPSDT Supplemental ServicesProvider Social Work 08/08/2006Holly C
AdamsEPSDT Supplemental ServicesProvider Social Work 05/01/1991Rosa
AdamsonEPSDT Supplemental ServicesProvider Social Work 11/06/2006Carol E
Page 2 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Adamson Audiologist Audiology 03/05/2009Julie L
AdcockEPSDT Supplemental ServicesProvider Social Work 05/20/2011Kimberly M
AddisonEPSDT Supplemental ServicesProvider Social Work 11/08/2012Donna
AdevaEPSDT Supplemental ServicesProvider Social Work 03/05/2012Sarah S
Adjan Physician Pediatrics 09/29/2009Roula S
Adler Audiologist Audiology 08/03/2012Bethany A
AdlerEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/31/2011Stacey B
AgajanianEPSDT Supplemental ServicesProvider Social Work 03/02/2007Tara E
Page 3 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
AgopianEPSDT Supplemental ServicesProvider Social Work 02/22/2005Sossy
AguiarEPSDT Supplemental ServicesProvider Social Work 07/06/2007Delia C
AguilarEPSDT Supplemental ServicesProvider Social Work 02/15/2006Delia V
Aguilar Physician Pediatrics 01/01/1997Edita Soriano
Aguirre Physical Therapist Physical Therapy 10/20/2009Debra K
Aguirre Occupational Therapist Occupational Therapy 03/16/2010Jael
Aguirre-Kolb Psychologist Psychology 03/06/2012Christina A
AgundezEPSDT Supplemental ServicesProvider Social Work 03/01/2010Phyllis A
Page 4 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
AhluwaliaEPSDT Supplemental ServicesProvider Dietetics 12/19/2006Dolly B
Ahn-YiEPSDT Supplemental ServicesProvider Social Work 11/16/2007Kelly E
AhrensEPSDT Supplemental ServicesProvider Social Work 07/07/2006Rebecca N
Ahumada-MocorroEPSDT Supplemental ServicesProvider Social Work 04/26/2011Lorena
Ailes Occupational Therapist Occupational Therapy 05/19/2009Lisa A
AineEPSDT Supplemental ServicesProvider Dietetics 02/02/2012Ruth E
Aiona Physician Orthopaedic Surgery 02/01/1989Michael D
Aldana Physician Pediatrics 02/22/2002Nancy V
Page 5 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
AldazEPSDT Supplemental ServicesProvider Dietetics 10/10/2007Vanessa J
Al-Dwairi PhysicianInternal Medicine: InfectiousDisease 12/18/2007Abdullah M
Ali Physician Pediatrics 02/01/2001Yusuf
Allan Occupational Therapist Occupational Therapy 01/23/2008Mary J
Allen Speech Therapist Speech Language Pathology 03/01/1974Elizabeth J
Allen Physical Therapist Physical Therapy 11/01/1983Jeffrey S
AllenEPSDT Supplemental ServicesProvider Social Work 07/26/2007Jennifer L
Allen Physician Pediatrics 02/01/1967John P
Page 6 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Allen Psychologist Psychology 01/04/2007Lisa F
Allen Psychologist Psychology 08/24/2009Megan R
AllenEPSDT Supplemental ServicesProvider Social Work 04/03/2007Rachel
Allen Audiologist Audiology 12/01/2010Sally H
Allende Physician Internal Medicine 06/13/2006Jorge A
Allende Physician Pediatrics 06/13/2006Jorge A
Allison Audiologist Audiology 10/15/2009Jane M
AlmondEPSDT Supplemental ServicesProvider Dietetics 01/14/2008Susan J
Page 7 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Alvarez-TobiasEPSDT Supplemental ServicesProvider Social Work 09/09/2011Linday I
AlvesEPSDT Supplemental ServicesProvider Social Work 09/26/2007Linda M
AmarinEPSDT Supplemental ServicesProvider Social Work 12/02/2010Nancy L
AmaryEPSDT Supplemental ServicesProvider Dietetics 12/02/2008Amanda P
AmiraliEPSDT Supplemental ServicesProvider Dietetics 07/19/2010Jennifer A
Anderson Speech Therapist Speech Language Pathology 10/17/2005Anita K
AndersonEPSDT Supplemental ServicesProvider Social Work 11/24/2003Anne T
Anderson Psychologist Psychology 09/07/2010Rachel K
Page 8 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Andrasik Occupational Therapist Occupational Therapy 02/10/2012Kelly L
Andree Physician Pediatrics 08/29/2007Gregor
AndrewsEPSDT Supplemental ServicesProvider Social Work 03/03/2009Cristanna M
Andrews Physical Therapist Physical Therapy 07/06/2007Dana
AndricosEPSDT Supplemental ServicesProvider Social Work 02/28/2011Margaret H
AndrovichEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/23/2010Teresa M
AngEPSDT Supplemental ServicesProvider Social Work 10/01/1998Rachelle L
AnjanaEPSDT Supplemental ServicesProvider Dietetics 05/13/2009Fnu
Page 9 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Ankeny Speech Therapist Speech Language Pathology 02/22/2012Jamie L
Ansay Speech Therapist Speech Language Pathology 12/08/2009Kyna S
Anthony Physician Family Medicine 09/21/2010Odilia Fe O
Antioch Speech Therapist Speech Language Pathology 09/22/2009Nelly
AntonoffEPSDT Supplemental ServicesProvider Social Work 04/01/1999Arlene
AnzaldoEPSDT Supplemental ServicesProvider Dietetics 02/10/2012Rochelle R
Aoki Physician Pediatrics 09/12/2007Ellen M
AparicioEPSDT Supplemental ServicesProvider Social Work 07/09/2012Rebecca
Page 10 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
AppacharEPSDT Supplemental ServicesProvider Social Work 10/18/2010Lakshmi R
Appel Physician Family Medicine 04/15/2011James E
AppleEPSDT Supplemental ServicesProvider Social Work 01/20/2011Susan L
Aquino Physical Therapist Physical Therapy 07/18/2006Michelle Lynn P
Aragon-GettingerEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/02/2001Susana M
Arambulo Occupational Therapist Occupational Therapy 04/23/2012Abigail J
Aranda Physical Therapist Physical Therapy 04/12/2007Heidi L
Archipley Physical Therapist Physical Therapy 09/01/1992Tom
Page 11 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ArciniegaEPSDT Supplemental ServicesProvider Social Work 05/01/1992Theresa R
ArdekaniEPSDT Supplemental ServicesProvider Dietetics 09/18/2012Nooshin
AreeckalEPSDT Supplemental ServicesProvider Social Work 05/01/2007Jenee M
Arellano Occupational Therapist Occupational Therapy 02/03/2012Adriana E
ArellanoEPSDT Supplemental ServicesProvider Social Work 12/19/2006Barbara D
ArellanoEPSDT Supplemental ServicesProvider Social Work 06/14/2011Rachel N
Arevalo-PorcelliEPSDT Supplemental ServicesProvider Social Work 10/03/2006Patricia E
ArgabrightEPSDT Supplemental ServicesProvider Dietetics 11/10/2010Debra A
Page 12 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
AriasEPSDT Supplemental ServicesProvider Social Work 08/23/2010Karina
ArimaEPSDT Supplemental ServicesProvider Social Work 09/01/1995Hatsuko
ArmijoEPSDT Supplemental ServicesProvider Social Work 12/23/2011Lorie L
Armitage Occupational Therapist Occupational Therapy 05/19/2009Cathy E
Armitage Physical Therapist Physical Therapy 12/06/2001Denise
Armstrong Psychologist Psychology 08/14/2007Priscilla P
Arndt Occupational Therapist Occupational Therapy 08/22/2003Kimberly
ArredondoEPSDT Supplemental ServicesProvider Social Work 11/21/2003Lisa L
Page 13 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ArronteEPSDT Supplemental ServicesProvider Social Work 02/10/2011Carmen
Arrouk Physician Pediatrics 09/07/2010Rami
Arroyo Occupational Therapist Occupational Therapy 08/01/2001Lisa
Arsecularatne Physician Family Medicine 01/24/2007Latika D
Artz Occupational Therapist Occupational Therapy 04/05/2010Paula J
AsheEPSDT Supplemental ServicesProvider Social Work 11/04/2002Annette L
Asher Occupational Therapist Occupational Therapy 12/10/2009Sarita
AshlockEPSDT Supplemental ServicesProvider Social Work 03/20/2007C L
Page 14 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
AshworthEPSDT Supplemental ServicesProvider Dietetics 04/03/2007Gale M
AsioduEPSDT Supplemental ServicesProvider Social Work 03/10/2011Uche P
Aslam Occupational Therapist Occupational Therapy 06/25/2010Shaheen
Aslanian Occupational Therapist Occupational Therapy 02/06/2008Margaret J
Aspe Occupational Therapist Occupational Therapy 12/22/2009Misael E
Atencio Speech Therapist Speech Language Pathology 03/17/2009Melanie S
Ath Occupational Therapist Occupational Therapy 11/06/2007Ginger A
Aung Physician Pediatrics 07/30/2010Thinn T
Page 15 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
AvicolliEPSDT Supplemental ServicesProvider Social Work 08/09/2007Kristin M
AvilaEPSDT Supplemental ServicesProvider Social Work 02/13/2009Andrea Y
AvilaEPSDT Supplemental ServicesProvider Social Work 08/29/2006Hilda
AvilaEPSDT Supplemental ServicesProvider Social Work 10/16/2008Imelda
Avila Psychologist Psychology 10/28/2010Maria
Avina-CastilloEPSDT Supplemental ServicesProvider Social Work 05/26/2006Julissa M
AwadallahEPSDT Supplemental ServicesProvider Social Work 02/04/2011Nida
Aycock Speech Therapist Speech Language Pathology 03/24/2011Christy A
Page 16 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Ayvazian Psychologist Psychology 01/02/2007John A
Azarbal Physician Obstetrics and Gynecology 04/27/2007Said
Babo Physician Family Medicine 10/21/2011Mark E
Baca-Morgan Psychologist Psychology 03/07/2008Alexia
Bach Physician Pediatrics 09/12/2007Yvonne V
BaderEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/30/2012Marc N
Baffigo Physician Family Medicine 11/27/2002Ursula M
BagaiEPSDT Supplemental ServicesProvider Social Work 10/25/2010Meera
Page 17 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Bailey Physical Therapist Physical Therapy 05/22/2007Jennifer S
Bailey Orthotist Orthotics 06/06/2005Mark J
BainEPSDT Supplemental ServicesProvider Social Work 12/15/2005Stefan A
Baird-HendreyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/16/2012Patricia G
Baker Occupational Therapist Occupational Therapy 11/09/2011Anna L
Baker Physical Therapist Physical Therapy 12/16/2011Jimmie B
Baker Speech Therapist Speech Language Pathology 10/19/2009John E
BakerEPSDT Supplemental ServicesProvider Social Work 09/10/2012Josey
Page 18 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Baker Audiologist Audiology 04/17/2006Keleigh J
Balan Physician Anesthesiology 03/16/2010Nirmala
Baldwin Psychologist Psychology 08/07/2007Jr
Bales Occupational Therapist Occupational Therapy 05/22/2002Joanne
Ball Audiologist Audiology 03/10/2003Julie A
BallamyEPSDT Supplemental ServicesProvider Dietetics 02/13/2001Leah S
ballardEPSDT Supplemental ServicesProvider Social Work 03/01/2001madeline
BalmaEPSDT Supplemental ServicesProvider Social Work 01/20/2011Batina E
Page 19 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Balwan Speech Therapist Speech Language Pathology 05/07/2004Melea K
Balzotti Physical Therapist Physical Therapy 05/27/2009Angela J
BaneEPSDT Supplemental ServicesProvider Dietetics 02/23/2012Marissa D
Bangar Physician Pediatrics 10/07/2011Parmala K
Banks Physical Therapist Physical Therapy 01/14/2005Paul
Bankson Speech Therapist Speech Language Pathology 07/15/2008Donna E
banningEPSDT Supplemental ServicesProvider Social Work 07/06/2012pamela
BaraccoEPSDT Supplemental ServicesProvider Dietetics 01/24/2012Sarah R
Page 20 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BarbaEPSDT Supplemental ServicesProvider Dietetics 07/22/2008Brenda M
Barbee Audiologist Audiology 07/10/2006Christi M
Barbieri-Welge Psychologist Psychology 02/01/1999Rene L
Bargetto Audiologist Audiology 08/02/2000Gina D
Barkan Speech Therapist Speech Language Pathology 09/26/2001Vicki L
Barncord Psychologist Psychology 11/01/2000Stephen W
Barnes Speech Therapist Speech Language Pathology 06/01/1994Melethia J
BarnettEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/01/2005Kimberly
Page 21 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BarnhardtEPSDT Supplemental ServicesProvider Social Work 07/08/2008Deetta S
BarrEPSDT Supplemental ServicesProvider Dietetics 10/03/2007Emily M
Barraza Speech Therapist Speech Language Pathology 10/27/2005Alba
BarrettEPSDT Supplemental ServicesProvider Social Work 03/14/2011La Crystal
Barry Physician Internal Medicine 05/30/2007David C
Bartczak Orthotist Orthotics 06/01/1983Thomas
Barton Audiologist Audiology 05/13/2002Linda S
Bashar Occupational Therapist Occupational Therapy 06/24/2009Jennifer C
Page 22 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Bass Audiologist Audiology 11/03/2009Alice M
Bass Physical Therapist Physical Therapy 04/25/2006Martha A
Bassali Physician Pediatrics 01/31/2006Joanne B
BasurtoEPSDT Supplemental ServicesProvider Social Work 04/01/1996Jennifer
Bater Occupational Therapist Occupational Therapy 10/29/2012Melissa
Batista Psychologist Psychology 12/19/2011Melissa L
Baucom-ProEPSDT Supplemental ServicesProvider Dietetics 02/28/2007Colleen S
Baudino Psychologist Psychology 05/07/2009Lori M
Page 23 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Bauer Physician Orthopaedic Surgery 09/08/2011Andrea S
BauerEPSDT Supplemental ServicesProvider Social Work 03/01/1996Jennifer B
BaughEPSDT Supplemental ServicesProvider Dietetics 05/01/1995Nancy C
Baumgartner Psychologist Psychology 05/27/2009Anna L
Bautista-DurandEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/05/2012Maria Imelda
BaxterEPSDT Supplemental ServicesProvider Social Work 04/10/2001Myra L
Bayney-Fleener Speech Therapist Speech Language Pathology 02/27/2008Vattene
Bazan Occupational Therapist Occupational Therapy 05/14/2012Loriann Sau Lin
Page 24 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Bean Occupational Therapist Occupational Therapy 12/02/2003Tambia E
Beane Physical Therapist Physical Therapy 11/15/2010Jennifer A
Beane Occupational Therapist Occupational Therapy 11/01/1990Vicki L
BeattieEPSDT Supplemental ServicesProvider Social Work 07/15/2011Jess E
Beausang Physician Internal Medicine 10/03/2012Dana
Beausang PhysicianInternal Medicine: Endocrinology,Diabetes, and Metabolism 10/03/2012Dana
Becerra Audiologist Audiology 01/26/2010Christina I
Becker Speech Therapist Speech Language Pathology 04/20/2010Emily E
Page 25 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Becker Audiologist Audiology 02/17/2004Susan N
BeckhamEPSDT Supplemental ServicesProvider Social Work 02/14/2012Shelley
BeckwithEPSDT Supplemental ServicesProvider Dietetics 04/01/1995Patricia
BeddoeEPSDT Supplemental ServicesProvider Social Work 10/20/2011Bernice C
Beduya Physical Therapist Physical Therapy 06/18/2009Beverly S
BedworthEPSDT Supplemental ServicesProvider Social Work 08/08/2006Beverly A
BeginoEPSDT Supplemental ServicesProvider Social Work 01/17/2008Claudia E
BehmEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/06/2010Shirley
Page 26 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Behnke Physical Therapist Physical Therapy 08/27/2008Kimberly E
BeitelEPSDT Supplemental ServicesProvider Social Work 08/03/2006Gary D
Bell Occupational Therapist Occupational Therapy 09/14/2006Nancy M
BellEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 01/23/2012Traci D
Bella Speech Therapist Speech Language Pathology 01/01/1992Sally A
Bellamy Physical Therapist Physical Therapy 10/31/2002Sandra
Belmont Physical Therapist Physical Therapy 11/17/2008Sabrina L
Beltrami Occupational Therapist Occupational Therapy 07/01/1995Monica A
Page 27 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Bendell-Estroff Psychologist Psychology 11/27/2006Debra
Beneck Occupational Therapist Occupational Therapy 08/09/2010Amy L
Benes Speech Therapist Speech Language Pathology 07/06/2010Angela
Bengtsson Occupational Therapist Occupational Therapy 10/16/2012Maria Alejandra
BennEPSDT Supplemental ServicesProvider Social Work 01/08/2009Melanie C
BensonEPSDT Supplemental ServicesProvider Dietetics 03/22/2011Karen M
Ben-Tall Psychologist Psychology 05/15/2003Ayala
BentleyEPSDT Supplemental ServicesProvider Social Work 09/19/2008Rachel A
Page 28 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Berendes Audiologist Audiology 02/14/2008Shannon L
Berg Speech Therapist Speech Language Pathology 12/04/2001Brittany
Berkenkotter Psychologist Psychology 09/06/2007Eren G
BermanEPSDT Supplemental ServicesProvider Dietetics 04/05/2012Gilah L
Berman Physical Therapist Physical Therapy 09/08/2003Larry
BermudezEPSDT Supplemental ServicesProvider Social Work 07/09/2008Bernadine
BermundoEPSDT Supplemental ServicesProvider Social Work 03/01/1991Carmelita
Bernard Psychologist Psychology 05/01/2007Rebecca S
Page 29 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BernardiEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/12/2011Holly
Bernardino Prosthetist Prosthetics/Orthotics 09/21/2010James V
Bernstein Psychologist Psychology 05/06/2008Irit S
Berry Physical Therapist Physical Therapy 12/01/1987Cynthia A
Bertolli Physician Family Medicine 02/23/2012Thomas
BesmerEPSDT Supplemental ServicesProvider Dietetics 09/15/2010Aleyna T
BesmerEPSDT Supplemental ServicesProvider Dietetics 09/15/2010 09/15/2010Aleyna T
BesslerEPSDT Supplemental ServicesProvider Dietetics 07/01/1996Susan J
Page 30 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BetancourtEPSDT Supplemental ServicesProvider Social Work 01/26/2012Sandra L
BetzEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 06/24/2009Cecily
Beyer Physical Therapist Physical Therapy 10/21/2008April
BezaireEPSDT Supplemental ServicesProvider Dietetics 09/12/2011Heidi D
Bhat Physician Internal Medicine 08/27/2009Bala K
BianchiniEPSDT Supplemental ServicesProvider Dietetics 06/01/2012Ginevra
Biard Audiologist Audiology 01/13/2006Shelby J
Biard Speech Therapist Speech Language Pathology 01/13/2006Shelby J
Page 31 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BierEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/01/1996Betty J
BillsEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 12/13/2011Vicky L
Bina PhysicianPhysical Medicine andRehabilitation 07/13/2007Babak
Binder Physical Therapist Physical Therapy 08/14/2007Hayley A
BinderEPSDT Supplemental ServicesProvider Dietetics 03/14/2011Thomas G
Bingea Audiologist Audiology 08/01/1999Rebecca
Binnall Occupational Therapist Occupational Therapy 08/01/1991Deborah A
Bird Prosthetist Prosthetics 05/24/2010James M
Page 32 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Bird Orthotist Orthotics 10/25/2011Robert
BjorkEPSDT Supplemental ServicesProvider Social Work 04/01/1993Anna Lee N
BlackEPSDT Supplemental ServicesProvider Social Work 08/07/2007Dennis
Black Physical Therapist Physical Therapy 02/06/2007Erika L
Black Occupational Therapist Occupational Therapy 12/12/2005Talitha K
Blacketer Physician Family Medicine 12/17/2010Bethany
BlasEPSDT Supplemental ServicesProvider Social Work 08/10/2006Juan P
Blazer Physical Therapist Physical Therapy 08/15/2011Jennifer L
Page 33 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BleasdaleEPSDT Supplemental ServicesProvider Social Work 09/01/1995Holly D
Blessing Speech Therapist Speech Language Pathology 09/13/2005Ciara M
Blitz Physical Therapist Physical Therapy 08/22/2006Jill R
BlockEPSDT Supplemental ServicesProvider Social Work 05/22/2007Wendy N
Bloom Speech Therapist Speech Language Pathology 04/10/2009Lucy
BloombaumEPSDT Supplemental ServicesProvider Social Work 03/26/2001Elizabeth
Bloomquist Physical Therapist Physical Therapy 03/02/2008Holly R
BlumEPSDT Supplemental ServicesProvider Social Work 05/01/1991Stacey
Page 34 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BlumlEPSDT Supplemental ServicesProvider Dietetics 10/01/1998Renee M
BluntEPSDT Supplemental ServicesProvider Social Work 10/30/2008Erica G
BlyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/02/2010Trudy A
Boakes Physician Orthopaedic Surgery 09/01/1991Jennete
BocoboEPSDT Supplemental ServicesProvider Social Work 01/05/2004Omar A
Bodnyk Occupational Therapist Occupational Therapy 02/09/2009Susan T
Boettcher Psychologist Psychology 05/01/2007Mendy A
Bogetz-GelbEPSDT Supplemental ServicesProvider Social Work 04/23/2004Gail E
Page 35 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Bohn Physician Pediatrics 05/17/2011Marjorie A
BohnEPSDT Supplemental ServicesProvider Social Work 08/01/1994Ralph P
BoissierEPSDT Supplemental ServicesProvider Social Work 06/16/2011Natasha
Bojescu Physical Therapist Physical Therapy 05/19/2006Lorrie
Bojorquez Physical Therapist Physical Therapy 02/23/2011Lauren E
BolandianEPSDT Supplemental ServicesProvider Social Work 10/07/2008Chris P
Boling Physician Family Medicine 08/11/2009Michael J
BonillaEPSDT Supplemental ServicesProvider Social Work 04/10/2009Sandra E
Page 36 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BonovitzEPSDT Supplemental ServicesProvider Social Work 05/04/2007Marie B
Bonsall Occupational Therapist Occupational Therapy 11/02/2005Maria T
BoothbyEPSDT Supplemental ServicesProvider Dietetics 03/13/2006Joan T
Boparai Physician Pediatrics 06/11/2007Nanak S
Borba Physical Therapist Physical Therapy 01/26/2010Cassandra J
BorchEPSDT Supplemental ServicesProvider Social Work 03/16/2009Patrick G
BorgerEPSDT Supplemental ServicesProvider Dietetics 09/05/2007Amy J
Bosiljevac Audiologist Audiology 09/10/2007Teresa R
Page 37 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Bostock Physical Therapist Physical Therapy 05/08/2009Julie A
Bosworth Occupational Therapist Occupational Therapy 01/03/2008Celia A
Boterenbrood Occupational Therapist Occupational Therapy 10/19/2011Julie A
Bouchard Occupational Therapist Occupational Therapy 02/06/2002Katherine
BoulasEPSDT Supplemental ServicesProvider Dietetics 01/23/2012Mariam
Bowen Audiologist Audiology 10/30/2009David W
Bower Physician Family Medicine 02/21/2007Andrea
Bowerman Psychologist Psychology 04/18/2006Sara B
Page 38 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Bowers Speech Therapist Speech Language Pathology 05/22/2002Christy
Bowman Orthotist Orthotics 02/01/1996Gerald
Bowness Occupational Therapist Occupational Therapy 08/01/1997Denise F
Bowron Speech Therapist Speech Language Pathology 04/28/2010Amanda S
Boyd Physical Therapist Physical Therapy 02/27/2007Whitney E
Boyer Physical Therapist Physical Therapy 09/10/2012Laura A
Boyer Psychologist Psychology 05/01/2007Margaret C
BraatenEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/30/2012Charlotte L
Page 39 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Bracchi Audiologist Audiology 11/01/1999Audrey E
Brackett Physical Therapist Physical Therapy 01/09/2012Deborah L
Bradshaw Occupational Therapist Occupational Therapy 02/10/2012Ginny L
Brady Physical Therapist Physical Therapy 01/09/2003Karen
BrahmbhattEPSDT Supplemental ServicesProvider Social Work 12/20/2006Rajendra H
Brainerd Audiologist Audiology 11/24/1999Amy T
BrambilaEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/13/2011Adriana
Branco Physician Pediatrics 09/05/1996Nelson
Page 40 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BrantleyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 01/17/2012Antrina
Brase Physical Therapist Physical Therapy 11/27/2006Bernadette L
BrasseurEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/09/2010Kimberly S
Braun Audiologist Audiology 03/23/2000Donna
BravoEPSDT Supplemental ServicesProvider Social Work 02/08/2012Michelle N
BremondEPSDT Supplemental ServicesProvider Social Work 04/13/2011Stephanie
BremsethEPSDT Supplemental ServicesProvider Dietetics 05/18/2007Emily N
Brenan Physical Therapist Physical Therapy 08/25/2010Andrew D
Page 41 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Brent Audiologist Audiology 07/05/2012Brandy M
Breseno Physician Pediatrics 04/01/2000Justina M
Brewster Speech Therapist Speech Language Pathology 10/01/1991Joy W
Brexa Occupational Therapist Occupational Therapy 08/01/2004Jeanne M
Bricker Speech Therapist Speech Language Pathology 01/16/2007Renee S
Bridwell Occupational Therapist Occupational Therapy 10/05/2005Margaret L
Briggs Occupational Therapist Occupational Therapy 02/10/2012Michelle L
Briggs Occupational Therapist Occupational Therapy 02/10/2012Peter D
Page 42 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BriggsEPSDT Supplemental ServicesProvider Social Work 08/29/2008Sally S
BrinkEPSDT Supplemental ServicesProvider Social Work 09/01/1997Austin
Brinkman Physician Pediatrics 11/18/2010Alice M
BrinkoetterEPSDT Supplemental ServicesProvider Social Work 04/29/2008Laura J
BristowEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/13/2011Lauren B
Brodbeck-Rook Physical Therapist Physical Therapy 08/14/2007Christina E
BrokkenEPSDT Supplemental ServicesProvider Dietetics 03/21/2006Karen C
BrooksEPSDT Supplemental ServicesProvider Social Work 03/22/2004Dedra A
Page 43 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BrooksEPSDT Supplemental ServicesProvider Social Work 12/13/2004Jane B
Broom Occupational Therapist Occupational Therapy 03/22/2007Jessica R
BrosnahanEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/15/2012Cynthia M
BrotherwoodEPSDT Supplemental ServicesProvider Dietetics 09/24/2012Michelle Y
Broukhim Physician Anesthesiology 11/14/2011Mahnaz
BrownEPSDT Supplemental ServicesProvider Dietetics 11/25/2009Jessica L
BrownEPSDT Supplemental ServicesProvider Social Work 09/21/2010Julie A
Brown Occupational Therapist Occupational Therapy 05/01/1992Kerren D
Page 44 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BrownEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/16/2012Lisa E
Brown Speech Therapist Speech Language Pathology 01/27/2011Nancy
BrownEPSDT Supplemental ServicesProvider Social Work 05/31/2006Raenisha D
BrownEPSDT Supplemental ServicesProvider Dietetics 09/22/2009Shonda M
BrownleeEPSDT Supplemental ServicesProvider Dietetics 07/26/2011Jaclyn E
Broyard JohnsonEPSDT Supplemental ServicesProvider Social Work 05/09/2006Andrea M
Brunt Orthotist Orthotics 02/02/2006Gregory
BruschaberEPSDT Supplemental ServicesProvider Social Work 12/20/2005Gregg L
Page 45 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Brushwyler Physical Therapist Physical Therapy 09/23/2009Elizabeth D
Bryant Audiologist Audiology 02/22/2000Jonathan D
BryarsEPSDT Supplemental ServicesProvider Dietetics 10/01/2001Teresa
Buchanan Occupational Therapist Occupational Therapy 06/22/2005Brandi L
BucherEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/04/2011Barbara R
BuddEPSDT Supplemental ServicesProvider Social Work 11/17/2005Ingrid D
BuenoEPSDT Supplemental ServicesProvider Social Work 02/02/2012Angeli L
BuiEPSDT Supplemental ServicesProvider Social Work 05/07/2008Thanh T
Page 46 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BujoldEPSDT Supplemental ServicesProvider Dietetics 01/01/1995Carin R
Bull Speech Therapist Speech Language Pathology 08/01/2003Susanne H
BullockEPSDT Supplemental ServicesProvider Social Work 03/28/2003Dina D
Burfield Occupational Therapist Occupational Therapy 05/17/2006Lisa A
BurgeEPSDT Supplemental ServicesProvider Social Work 10/01/1997Mary E
Burgener-Vader Speech Therapist Speech Language Pathology 09/04/2012Stephanie A
Burger Speech Therapist Speech Language Pathology 03/29/2007Lisa C
Burhans Audiologist Audiology 08/31/1999Denise
Page 47 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
BurkEPSDT Supplemental ServicesProvider Social Work 11/08/2007Lynn A
Burke Physical Therapist Physical Therapy 10/27/2008Mary Ann
Burke Speech Therapist Speech Language Pathology 07/26/2012Meredith
Burke Physical Therapist Physical Therapy 11/01/2007Robert A
Burke-Doe Physical Therapist Physical Therapy 05/01/1999Annie P
Burkett Speech Therapist Speech Language Pathology 01/13/2009Sara
BurlandoEPSDT Supplemental ServicesProvider Social Work 07/11/2006Andrea J
BurokerEPSDT Supplemental ServicesProvider Social Work 04/12/2006Jacqueline J
Page 48 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Burr Audiologist Audiology 09/04/2012Heather Lynn
BurrittEPSDT Supplemental ServicesProvider Dietetics 02/10/2005Emily J
Burstein Physical Therapist Physical Therapy 07/15/2011Amir
BurtEPSDT Supplemental ServicesProvider Social Work 03/11/2011Stacy M
Burton Speech Therapist Speech Language Pathology 02/13/2004Wendy E
Bush Occupational Therapist Occupational Therapy 11/17/2008Judy E
Butkus Occupational Therapist Occupational Therapy 05/01/1997Lucille A
ButlerEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/03/2011Alexis S
Page 49 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ButlerEPSDT Supplemental ServicesProvider Dietetics 03/13/2007Camy H
ButtacavoliEPSDT Supplemental ServicesProvider Social Work 08/30/2007Stephanie S
Buxbaum Physician Pediatrics 08/17/2011Evan R
ByersEPSDT Supplemental ServicesProvider Social Work 03/01/2010Shirley J
Byrne Physical Therapist Physical Therapy 04/14/2003Eilish
CaballeroEPSDT Supplemental ServicesProvider Social Work 07/16/2010Dana L
CabanillasEPSDT Supplemental ServicesProvider Social Work 01/20/2012Christina
Cabasino Speech Therapist Speech Language Pathology 05/22/2006Bonnie J
Page 50 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Cabling Occupational Therapist Occupational Therapy 02/04/2008Grady P
Cachero Physical Therapist Physical Therapy 05/19/2009Alberto J
Cadger Occupational Therapist Occupational Therapy 04/14/2004Kari N
Cafferkey Speech Therapist Speech Language Pathology 07/06/2010Margaret L
Cagigas Psychologist Psychology 07/12/2010Xavier E
Cahill Occupational Therapist Occupational Therapy 05/19/2009Lisa A
CalderonEPSDT Supplemental ServicesProvider Social Work 07/22/2011Nelson L
Caldwell Audiologist Audiology 11/16/2006Sandra I
Page 51 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Caldwell-Miller Audiologist Audiology 07/29/2004Mikal M
Calhoon Physical Therapist Physical Therapy 09/29/2006Bonnie R
Calhoun Physician Pediatrics 12/01/1996Chanelle R
Calhoun Physician Radiology: Diagnostic 09/11/2012Shannon P
Callahan Psychologist Psychology 05/07/2007Patrick J
Callihan Orthotist Orthotics 05/28/2010Fredrick
Calonico Psychologist Psychology 11/17/2009Lynne D
Camarero-MorseEPSDT Supplemental ServicesProvider Social Work 02/24/2006Veronica S
Page 52 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Cameron Physical Therapist Physical Therapy 04/11/2011Sandra D
CaminoEPSDT Supplemental ServicesProvider Social Work 07/17/2007Lisa J
Campa Audiologist Audiology 05/31/2002Connie L
Campanella DurandEPSDT Supplemental ServicesProvider Social Work 08/14/2012Lori
CampbellEPSDT Supplemental ServicesProvider Social Work 12/21/2011Robin M
Cantrill Occupational Therapist Occupational Therapy 04/23/2009Katherine U
Capasso Audiologist Audiology 05/12/2011Cintia B
Capell PhysicianPhysical Medicine andRehabilitation 11/01/1979Joseph T
Page 53 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
CaputoEPSDT Supplemental ServicesProvider Dietetics 01/12/2011Selene M
Caragher Speech Therapist Speech Language Pathology 10/11/2006Ann L
Carazo Occupational Therapist Occupational Therapy 05/19/2009Marcela
CareyEPSDT Supplemental ServicesProvider Dietetics 08/04/2011Hilda M
Carigma Physician Pediatrics 12/22/2009Cecilia S
CarlsonEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/14/2011Alesha A
Carlstrom PhysicianPhysical Medicine andRehabilitation: Spinal Cord InjuryMedicine
03/08/2006Carmen M
Carlucci Physical Therapist Physical Therapy 03/27/2007Joseph J
Page 54 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Carman Audiologist Audiology 07/21/2011Sabra C
Carmean Physical Therapist Physical Therapy 04/30/2010Melissa A
CarmichaelEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/24/2011Jerod W
Carr Physical Therapist Physical Therapy 02/09/2012Keegan A
CarranzaEPSDT Supplemental ServicesProvider Social Work 06/12/2007Elizabeth
Carrell Speech Therapist Speech Language Pathology 02/17/2004Stacy C
CarreraEPSDT Supplemental ServicesProvider Social Work 05/14/2004Cristina M
Carrera Speech Therapist Speech Language Pathology 10/21/2008Molly E
Page 55 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Carrillo Speech Therapist Speech Language Pathology 09/17/2003Laura L
Carrington Occupational Therapist Occupational Therapy 03/16/2004Andre L
CarrollEPSDT Supplemental ServicesProvider Social Work 02/04/2011Lauren
Carroll Physical Therapist Physical Therapy 07/08/2008Lisa
CarrollEPSDT Supplemental ServicesProvider Social Work 03/20/2007Lisa D
CarruthersEPSDT Supplemental ServicesProvider Dietetics 01/13/2009Janet L
CarsonEPSDT Supplemental ServicesProvider Dietetics 11/13/2007Margie I
Carter Physical Therapist Physical Therapy 10/29/2012Kelly I
Page 56 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Carter Occupational Therapist Occupational Therapy 09/01/1998Kimberly
CarterEPSDT Supplemental ServicesProvider Social Work 09/09/2004Kirsten
Carter Occupational Therapist Occupational Therapy 06/09/2006Lise H
CarterEPSDT Supplemental ServicesProvider Social Work 01/20/2011Stephanie C
Case Prosthetist Prosthetics 06/01/1984Philip A
Casey Orthotist Orthotics 07/28/2010Michael P
Caskey Physician Radiology: Diagnostic 08/01/2012Cynthia
CassidyEPSDT Supplemental ServicesProvider Social Work 04/11/2012Colleen M
Page 57 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
CassidyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/09/2010Teresa M
CastanedaEPSDT Supplemental ServicesProvider Social Work 05/13/2011Elizabeth J
CastanedaEPSDT Supplemental ServicesProvider Social Work 07/21/2009Monique D
CastilloEPSDT Supplemental ServicesProvider Social Work 09/27/2002Carmen M
Castillo Physical Therapist Physical Therapy 12/26/2003Michael
CastilloEPSDT Supplemental ServicesProvider Social Work 11/01/1988Rosa M
Castro Occupational Therapist Occupational Therapy 04/14/2006Guadalupe C
Castro Physical Therapist Physical Therapy 09/13/2010Ilene S
Page 58 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
CaugheyEPSDT Supplemental ServicesProvider Social Work 10/12/2007Jessica S
Cavanaugh Physical Therapist Physical Therapy 04/16/2008Alyson M
Cavazos Audiologist Audiology 11/03/1999Cynthia Ann
Cave Physical Therapist Physical Therapy 04/30/2007Joscelyn
CedanaEPSDT Supplemental ServicesProvider Social Work 05/01/1994Perseveranda
Celada Physician Surgery: (general) 05/16/2012Roberto
CendejasEPSDT Supplemental ServicesProvider Social Work 07/27/2006Tessa R
Centra Occupational Therapist Occupational Therapy 03/03/2004Wayne B
Page 59 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Cervantes Occupational Therapist Occupational Therapy 09/30/2008Joel M
ChaEPSDT Supplemental ServicesProvider Social Work 02/27/2006Jieun
ChafinEPSDT Supplemental ServicesProvider Social Work 12/08/2011Sandra R
ChaiEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/20/2010Emy M
ChamblessEPSDT Supplemental ServicesProvider Social Work 01/21/2009Shearly
Chan Physical Therapist Physical Therapy 05/07/2012Franklin A
Chan Occupational Therapist Occupational Therapy 10/10/2008Jennifer M
Chan Physical Therapist Physical Therapy 11/07/2006Katrina L
Page 60 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Chan Physical Therapist Physical Therapy 03/29/2005Marie M
ChanEPSDT Supplemental ServicesProvider Social Work 12/08/2010Patricia
Chan Occupational Therapist Occupational Therapy 01/01/1985Shirley W
Chandler Physician Obstetrics and Gynecology 02/05/2008Peter J
Chandrasekhar Physician Internal Medicine 07/23/2007Jayaraman
Chandrasekhar PhysicianInternal Medicine: Critical CareMedicine 07/23/2007Jayaraman
ChangEPSDT Supplemental ServicesProvider Dietetics 07/01/1995Joyce H
Chang Physician Pediatrics 07/30/2010Kwi Bum
Page 61 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Chang Psychologist Psychology 06/01/2010Nelrose C
Chang Occupational Therapist Occupational Therapy 06/19/2007Tina
Chang Audiologist Audiology 07/01/2001Wileen
Chantaphakul Speech Therapist Speech Language Pathology 02/22/2012Chantawan
ChappellEPSDT Supplemental ServicesProvider Social Work 04/23/2012Debra R
CharboneauEPSDT Supplemental ServicesProvider Dietetics 09/08/2008Kelly M
ChavarinEPSDT Supplemental ServicesProvider Social Work 02/05/2008Teresa D
ChavezEPSDT Supplemental ServicesProvider Social Work 09/25/2009Carrie L
Page 62 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Chavez Physical Therapist Physical Therapy 09/23/2008Jennifer A
ChavezEPSDT Supplemental ServicesProvider Social Work 02/23/2010John
Chavez Physical Therapist Physical Therapy 10/29/2012Margo J
ChavezEPSDT Supplemental ServicesProvider Social Work 03/17/2008Maria G
ChavezEPSDT Supplemental ServicesProvider Social Work 11/08/2007Rocio
ChavezEPSDT Supplemental ServicesProvider Social Work 01/19/2012Susie
Chavez MatzelEPSDT Supplemental ServicesProvider Social Work 06/19/2007Stephen M
Chee Occupational Therapist Occupational Therapy 09/18/2003Nancy B
Page 63 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Chemodurow PhysicianPsychiatry and Neurology:Psychiatry 07/24/2012Katherine
Chen Physician Pediatrics 01/23/2008Agnes H
Chen PhysicianPsychiatry and Neurology: SpecialQualifications in Child Neurology 02/21/2008Agnes H
Chen Physician Family Medicine 10/10/2012Bridget
Chen Physician Pediatrics 08/08/2008Jamesina T
ChenEPSDT Supplemental ServicesProvider Social Work 09/17/2007Tuyet N
ChenEPSDT Supplemental ServicesProvider Dietetics 06/30/2004Winy H
Cheney Physician Pediatrics 11/01/1964Nancy A
Page 64 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Cheng Physician Family Medicine 03/28/2006Kwokming J
Cheng Physical Therapist Physical Therapy 02/01/2012Mei-Sze
CherryEPSDT Supplemental ServicesProvider Dietetics 04/02/2009Lisa A
Cheung Physical Therapist Physical Therapy 03/24/2009Danielle S
ChinEPSDT Supplemental ServicesProvider Dietetics 01/01/1995Debra
Chinchilla Audiologist Audiology 07/31/2012Sherol S
Ching Occupational Therapist Occupational Therapy 12/13/2005Eva B
Chiu Physical Therapist Physical Therapy 05/02/2012Jennifer Marie
Page 65 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Chivichon-NavarroEPSDT Supplemental ServicesProvider Dietetics 10/18/2011Nancy E
Chizek Occupational Therapist Occupational Therapy 02/09/2009Celeste A
ChoEPSDT Supplemental ServicesProvider Social Work 01/09/2012Abigail J
Cho Occupational Therapist Occupational Therapy 01/05/2010Angela B
ChoEPSDT Supplemental ServicesProvider Dietetics 06/25/2010Janice
Choi Audiologist Audiology 12/07/2010David H
Choi Physical Therapist Physical Therapy 10/20/2005Kailine L
ChouEPSDT Supplemental ServicesProvider Dietetics 09/01/2011Hsien-Hea S
Page 66 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Chow Physician Pediatrics 09/01/2003 09/01/2003Byron C
ChowEPSDT Supplemental ServicesProvider Social Work 12/20/2006Lily Y
ChristensenEPSDT Supplemental ServicesProvider Social Work 10/16/2008Caine P
ChristensenEPSDT Supplemental ServicesProvider Dietetics 10/31/2005Helen H
ChristensenEPSDT Supplemental ServicesProvider Social Work 02/13/2009Kristie M
ChristianEPSDT Supplemental ServicesProvider Dietetics 11/17/2004Mary J
ChristieEPSDT Supplemental ServicesProvider Dietetics 05/25/2012Mary Beth
Christmas Physical Therapist Physical Therapy 01/26/2006Arden J
Page 67 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Chua Physical Therapist Physical Therapy 02/14/2007Helen Grace K
Chudy Physician Family Medicine 04/28/2010Joseph Hyman A
ChungEPSDT Supplemental ServicesProvider Social Work 02/03/2011Carol Y
Chung Occupational Therapist Occupational Therapy 02/16/2010David
ChungEPSDT Supplemental ServicesProvider Dietetics 02/03/2006Janet
Church Physical Therapist Physical Therapy 05/29/2012Cassandra Sabrina
CieszynskiEPSDT Supplemental ServicesProvider Social Work 11/16/2006Thomas B
CihuacoatlEPSDT Supplemental ServicesProvider Dietetics 12/28/2011Yesenia
Page 68 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Cimicato Physical Therapist Physical Therapy 10/19/2010Lysa
Cinco Physical Therapist Physical Therapy 06/01/1994Renee M
CinquemaniEPSDT Supplemental ServicesProvider Dietetics 06/25/2010Dino B
CiscoEPSDT Supplemental ServicesProvider Social Work 07/22/2008Renee E
ClabaughEPSDT Supplemental ServicesProvider Social Work 10/01/1995Joyce A
Clark Orthotist Orthotics 05/06/2011Darrell R
ClarkEPSDT Supplemental ServicesProvider Social Work 06/01/1999Deann
Clarke Psychologist Psychology 01/17/2006Pamela
Page 69 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Clarno Physical Therapist Physical Therapy 03/13/2012Kim Strauss
ClashEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/25/2003Kimberly E
ClausonEPSDT Supplemental ServicesProvider Dietetics 06/30/2010Sarah L
ClaytonEPSDT Supplemental ServicesProvider Social Work 08/23/2007Jerome L
ClaytonEPSDT Supplemental ServicesProvider Social Work 10/21/2008Rochelle A
ClaytorEPSDT Supplemental ServicesProvider Social Work 11/06/2007Joanne
Clemens Physical Therapist Physical Therapy 01/03/2005Kimberly A
CliffordEPSDT Supplemental ServicesProvider Social Work 08/08/2006Sheila M
Page 70 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
CliftonEPSDT Supplemental ServicesProvider Social Work 09/08/2006Romaine I
Cloutier-ChaineEPSDT Supplemental ServicesProvider Social Work 08/28/2006Randie
Clymer Physical Therapist Physical Therapy 02/09/2010Laurel M
Coakley Psychologist Psychology 04/19/2007Heather N
Cobos Audiologist Audiology 07/01/2010Sandra
Coca Speech Therapist Speech Language Pathology 03/08/2010Laura S
CoenEPSDT Supplemental ServicesProvider Social Work 11/01/2012Myrna S
CoffmanEPSDT Supplemental ServicesProvider Dietetics 01/11/2008Caryn J
Page 71 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
CoffmanEPSDT Supplemental ServicesProvider Social Work 05/01/1991Katherine
Coggiola Speech Therapist Speech Language Pathology 12/15/2009Jennifer L
CohenEPSDT Supplemental ServicesProvider Social Work 04/10/2008Jamie M
CohenEPSDT Supplemental ServicesProvider Dietetics 01/18/2007Tori S
CohnEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/13/2010Tricia L
ColarussoEPSDT Supplemental ServicesProvider Social Work 10/18/2010Linda R
Colella Physical Therapist Physical Therapy 12/01/2010Dana L
ColemanEPSDT Supplemental ServicesProvider Social Work 10/05/2007Marcelyn J
Page 72 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ColemanEPSDT Supplemental ServicesProvider Social Work 12/26/2007Melissa J
Coll Audiologist Audiology 09/13/2006Melanie T
CollardeyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/27/2010Kelly R
Colle Physical Therapist Physical Therapy 04/07/2010Merilee
Collier Physical Therapist Physical Therapy 03/13/2003Chris
Collins Orthotist Orthotics 08/19/2004Patricia L
Collins Occupational Therapist Occupational Therapy 12/24/2008Resenia V
CombsEPSDT Supplemental ServicesProvider Social Work 07/28/2009Lola M
Page 73 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Coming Audiologist Audiology 02/16/2004Rebecca S
ComsaEPSDT Supplemental ServicesProvider Social Work 05/04/2007Stacey N
Conahan Physician Family Medicine 10/10/2012REbecca
ConferEPSDT Supplemental ServicesProvider Social Work 10/14/2008Linda L
Conlin Occupational Therapist Occupational Therapy 03/05/2001Lisa
Conneely Occupational Therapist Occupational Therapy 04/09/2007Christina M
ConnerEPSDT Supplemental ServicesProvider Social Work 07/26/2006Denenea L
Connolly Physical Therapist Physical Therapy 11/08/2006Joan M
Page 74 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ConnorEPSDT Supplemental ServicesProvider Dietetics 09/19/2008Katherine H
Connor PhysicianPsychiatry and Neurology:Psychiatry 12/16/2010Willard W
Contes Occupational Therapist Occupational Therapy 01/12/2009Danielle M
ContrerasEPSDT Supplemental ServicesProvider Social Work 01/22/2007Rosalinda
Contreras-VasquezEPSDT Supplemental ServicesProvider Social Work 11/10/2009Evelia
CoobteeEPSDT Supplemental ServicesProvider Social Work 11/01/2012Muna
CookEPSDT Supplemental ServicesProvider Social Work 02/26/2008Dana A
Cook Physical Therapist Physical Therapy 09/01/2011Joanne F
Page 75 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
CookEPSDT Supplemental ServicesProvider Social Work 06/28/2001Mylene Z
Cook Prosthetist Prosthetics/Orthotics 10/18/2010Robert A
Cook-Chambi Occupational Therapist Occupational Therapy 11/20/1985Patiricia A
Cooper Audiologist Audiology 05/31/2002Carolyn R
Cooper Speech Therapist Speech Language Pathology 06/27/2006Janice L
Cooper Physical Therapist Physical Therapy 10/11/2002Joel N
Cooper Occupational Therapist Occupational Therapy 09/22/2009Paul S
CopelandEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/14/2011Anna L
Page 76 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Copi PhysicianPsychiatry and Neurology:Psychiatry 05/30/2012Margaret
CoppockEPSDT Supplemental ServicesProvider Dietetics 08/05/2011Johnna L
CorbettEPSDT Supplemental ServicesProvider Social Work 08/09/2012Carolyn
Corbett Physical Therapist Physical Therapy 05/01/1993John
CorbittEPSDT Supplemental ServicesProvider Social Work 01/24/2002Courtney
CorderoEPSDT Supplemental ServicesProvider Social Work 06/08/2012Edward S
Corey Occupational Therapist Occupational Therapy 01/26/2009Scott R
Cornell Physical Therapist Physical Therapy 06/15/2004Nikki S
Page 77 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
CornwallEPSDT Supplemental ServicesProvider Dietetics 09/09/2011Catherine M
Coronado-KingEPSDT Supplemental ServicesProvider Social Work 01/03/2012Grace
CorrEPSDT Supplemental ServicesProvider Social Work 12/17/2002Monika
Corsiglia Psychologist Psychology 07/12/2007Victor F
Cortney Physical Therapist Physical Therapy 08/29/2008Catherine S
CostaEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 03/13/2007Kathy L
CostaEPSDT Supplemental ServicesProvider Dietetics 01/09/2012Kimberly A
Cota Speech Therapist Speech Language Pathology 05/04/2012Jennifer
Page 78 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
CotterEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/28/2011Catherine H
CoulterEPSDT Supplemental ServicesProvider Social Work 12/09/2011Angela
CovarrubiasEPSDT Supplemental ServicesProvider Social Work 08/10/2006Raul
CoveyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/09/2010Misty D
Cowell Occupational Therapist Occupational Therapy 10/22/2008Karen M
Cowell Physician Pediatrics 02/24/2010Melissa
Cowen Speech Therapist Speech Language Pathology 11/06/2007Laura J
Cox Physical Therapist Physical Therapy 11/06/2007Rebecca
Page 79 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
CraigEPSDT Supplemental ServicesProvider Social Work 11/16/2011Jana K
CraigEPSDT Supplemental ServicesProvider Social Work 09/01/2011Judy K
Crawford Audiologist Audiology 12/05/2008Joyce B
Creamer Physical Therapist Physical Therapy 06/24/2011Megan N
CreangaEPSDT Supplemental ServicesProvider Dietetics 07/16/2012Emilia L
Crespo-BelardeEPSDT Supplemental ServicesProvider Social Work 09/18/2012Romana
Crew Physical Therapist Physical Therapy 06/08/2010Robert D
Crickmore Speech Therapist Speech Language Pathology 10/12/2007Maren E
Page 80 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
CrislerEPSDT Supplemental ServicesProvider Social Work 07/14/2005Danielle N
Cronan Occupational Therapist Occupational Therapy 08/15/2008Stephanie M
Cronin Speech Therapist Speech Language Pathology 10/11/2002Andrea M
Cross Physical Therapist Physical Therapy 01/30/2009Maureen E
CrossEPSDT Supplemental ServicesProvider Social Work 04/29/2009Sallyann M
CrouseEPSDT Supplemental ServicesProvider Dietetics 01/25/2006Barbara A
Croutch Audiologist Audiology 03/27/2003Carl A
CroweEPSDT Supplemental ServicesProvider Social Work 08/12/2003Ruth M
Page 81 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
CruseEPSDT Supplemental ServicesProvider Social Work 11/16/1999Michael
CruzEPSDT Supplemental ServicesProvider Social Work 10/21/2008Amy E
CuanEPSDT Supplemental ServicesProvider Social Work 11/01/2007Martha L
Cuccia Physical Therapist Physical Therapy 01/26/2006Lisa D
Cunanan Physician Family Medicine 07/26/2010Maria
CunninghamEPSDT Supplemental ServicesProvider Dietetics 10/11/2010Jacklyn R
Cunningham Occupational Therapist Occupational Therapy 01/19/2011Stacey B
CunninghamEPSDT Supplemental ServicesProvider Social Work 10/03/2006Theresa M
Page 82 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Cunningham Speech Therapist Speech Language Pathology 05/25/2012Theresa Boyle
Cuomo Physician Orthopaedic Surgery 11/14/2011Anna
Curran Audiologist Audiology 11/14/2007Katharine E
Curran Physical Therapist Physical Therapy 06/10/2008Thomas L
Currie Physician Family Medicine 01/22/2008 01/22/2008Helen
Currie Physician Pediatrics 01/22/2008Helen
CurtisEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/01/2010Karen R
CusickEPSDT Supplemental ServicesProvider Social Work 10/12/2007Laila J
Page 83 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DabelEPSDT Supplemental ServicesProvider Dietetics 11/13/2008Kelly E
Daems Occupational Therapist Occupational Therapy 02/01/1992Joan
Daftari Physician Pediatrics 06/17/2010Babak
D'AgostinoEPSDT Supplemental ServicesProvider Social Work 01/21/2010Carolyn B
Dahnke Physical Therapist Physical Therapy 04/06/2011Kathleen A
Dainty Physician Obstetrics and Gynecology 07/31/2012 07/30/2015Erin
Dalal Physical Therapist Physical Therapy 02/06/2007Husena H
dallasEPSDT Supplemental ServicesProvider Social Work 07/06/2012barbara
Page 84 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Damanan Physician Pediatrics 05/22/2008Sonia
Dammen Audiologist Audiology 04/15/2009Jennifer L
Damo Occupational Therapist Occupational Therapy 12/06/2006Elaine
Damon Physical Therapist Physical Therapy 02/01/2006Marianne N
DancyEPSDT Supplemental ServicesProvider Social Work 04/16/2004Michelle R
DanekEPSDT Supplemental ServicesProvider Social Work 05/30/2000Glenda A
Dang Occupational Therapist Occupational Therapy 10/04/2011 10/04/2011Myron T
Dange Physician Pediatrics 11/07/2007Rajiv P
Page 85 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Dangelo PhysicianPsychiatry and Neurology:Addiction Psychiatry 12/12/2011Ernani J
Daniyan Physician Pediatrics 05/25/2010Samuel A
Danovsky Psychologist Psychology 09/01/1997Michael B
Dao Occupational Therapist Occupational Therapy 10/21/2008Leilanie A
DaoEPSDT Supplemental ServicesProvider Social Work 08/08/2006Minh Tram N
DarceyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 01/01/1995Anita M
Darm Physical Therapist Physical Therapy 01/28/2010Susan E
DautrichEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/03/2012Lucy
Page 86 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DavalosEPSDT Supplemental ServicesProvider Social Work 06/10/2010Eduardo
Davenport Audiologist Audiology 05/16/2011Kelli L
Davids Physician Orthopaedic Surgery 07/27/2011Jon R
DavidsonEPSDT Supplemental ServicesProvider Social Work 03/28/2012Jill
DavidsonEPSDT Supplemental ServicesProvider Social Work 10/01/1986Velma
Davillier-WellauerEPSDT Supplemental ServicesProvider Social Work 08/03/2006Lizette A
Davis Physical Therapist Physical Therapy 12/29/2010Aimee C
Davis Prosthetist Prosthetics/Orthotics 06/11/2008Howard E
Page 87 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Davis Audiologist Audiology 10/05/2006Rose Marie S
Davis Occupational Therapist Occupational Therapy 10/09/2007Terryn D
DavisEPSDT Supplemental ServicesProvider Social Work 03/28/2006Yomara L
Davis-GainesEPSDT Supplemental ServicesProvider Social Work 09/14/2010Felecia
Davison Speech Therapist Speech Language Pathology 10/06/2008Deborah L
Davisson Occupational Therapist Occupational Therapy 06/16/2007Antoinette H
DavyEPSDT Supplemental ServicesProvider Dietetics 02/09/2009Merari R
Day Physical Therapist Physical Therapy 09/01/1987Lauraine L
Page 88 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DayEPSDT Supplemental ServicesProvider Social Work 01/30/2008Smitha
Day-Scarinci Physician Pediatrics 08/24/2011Morag N
Dean Psychologist Psychology 12/05/2011Grace E
Dean Audiologist Audiology 10/01/2000Jeffery L
Dearden Occupational Therapist Occupational Therapy 05/01/1992Beverly L
DebattistaEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/26/2003Anne M
Debay Physician Family Medicine 10/21/2011Marc
Decristoforo Psychologist Psychology 07/01/2003Lora A
Page 89 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DeeneyEPSDT Supplemental ServicesProvider Social Work 03/03/2004Kerry
DeetsEPSDT Supplemental ServicesProvider Dietetics 02/01/1995Coleen
DefazioEPSDT Supplemental ServicesProvider Dietetics 11/13/2007Karen E
De Guzman Physician Pediatrics 11/01/1979Aurora L
Deguzman Physical Therapist Physical Therapy 11/22/2010Eleanor A
De La LozaEPSDT Supplemental ServicesProvider Social Work 08/09/2007Mary N
De La Torre Physical Therapist Physical Therapy 10/16/2012Ernesto
De LeonEPSDT Supplemental ServicesProvider Dietetics 02/17/2009Lorelie
Page 90 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Deleon Physical Therapist Physical Therapy 01/28/2008Rosanna G
DelgadoEPSDT Supplemental ServicesProvider Social Work 05/14/2012Miriam C
Delgado Physical Therapist Physical Therapy 04/03/2007Robert L
Del Homme Psychologist Psychology 08/27/2008Melissa A
DellEPSDT Supplemental ServicesProvider Social Work 05/21/2004Heidi
DeloteEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/03/2011Dennis V
Del ToroEPSDT Supplemental ServicesProvider Social Work 04/04/2008Julie M
DemarchiEPSDT Supplemental ServicesProvider Dietetics 08/07/2007Joanne
Page 91 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DemareeEPSDT Supplemental ServicesProvider Social Work 10/23/2012Michelle Lorraine
DenisEPSDT Supplemental ServicesProvider Dietetics 02/01/1995Dana C
DepewEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/08/2011Nicole M
Desai PhysicianPsychiatry and Neurology:Neurology 08/29/2012Bindu
Desai Speech Therapist Speech Language Pathology 12/12/2006Hema
Desai Physician Family Medicine 12/12/2007Nilima N
Desai Physical Therapist Physical Therapy 08/06/2007Roshni S
Deshaies Occupational Therapist Occupational Therapy 01/17/2002Lisa
Page 92 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Dettman Audiologist Audiology 04/15/2009Karen A
DevitoEPSDT Supplemental ServicesProvider Social Work 09/26/2007Candice N
DevlinEPSDT Supplemental ServicesProvider Social Work 03/01/1995Donna
DewareEPSDT Supplemental ServicesProvider Social Work 06/30/2012Joanna
Dewey Physical Therapist Physical Therapy 01/31/2008April L
DewhirstEPSDT Supplemental ServicesProvider Dietetics 11/13/2008Melinda S
Deyo Audiologist Audiology 03/15/2004Melissa D
DhingraEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/06/2012Chaula M
Page 93 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Diablo Prostheticsand Or Prosthetist Prosthetics/Orthotics 02/21/2012
Dias Audiologist Audiology 02/04/2005Maria
DiazEPSDT Supplemental ServicesProvider Dietetics 10/25/2002Audra R
Dibble Occupational Therapist Occupational Therapy 03/23/2010Jane G
DickersonEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/03/2011Sonia D
Dicks Physical Therapist Physical Therapy 04/05/2006Gitta
Dickson Speech Therapist Speech Language Pathology 02/27/2007Karen A
DiebelEPSDT Supplemental ServicesProvider Dietetics 10/13/2009Eloise C
Page 94 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DiesteEPSDT Supplemental ServicesProvider Social Work 09/21/2011Desiree
Di Geronimo Occupational Therapist Occupational Therapy 03/29/2003Mary J
Diggs Audiologist Audiology 08/22/2011Jovona L
Dildine Psychologist Psychology 03/16/2006Danielle A
Dilliner Physical Therapist Physical Therapy 06/09/2006Stephanie
Dillon-Stathacopulos Speech Therapist Speech Language Pathology 09/21/2010Jessica L
Dimond Speech Therapist Speech Language Pathology 01/08/2008Laura C
Din Physician Family Medicine 08/11/2009Alaud
Page 95 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DinglasanEPSDT Supplemental ServicesProvider Social Work 07/31/2007Sumaya A
DinhEPSDT Supplemental ServicesProvider Social Work 05/07/2008Kieu-Loan V
Di Pinto Psychologist Psychology 04/21/2009Marcos
Diskin Occupational Therapist Occupational Therapy 07/01/1996Faye
Distelberg Physical Therapist Physical Therapy 03/05/2004Leann M
Dixon Psychologist Psychology 04/01/2008J F
Dixon Speech Therapist Speech Language Pathology 11/01/2005Jill M
Dixon Physician Pediatrics 08/24/2011Kimberly D
Page 96 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Dixon-Brown Audiologist Audiology 03/13/2006Marilyn M
Dixon-FlowersEPSDT Supplemental ServicesProvider Social Work 12/27/2011Rose M
Dizon-Sinocruz Physical Therapist Physical Therapy 07/31/2009Karen M
Do Occupational Therapist Occupational Therapy 01/30/2007Loann K
Do Physician Internal Medicine 08/22/2012 08/21/2015Minh
Dobbins Physical Therapist Physical Therapy 11/16/2011Rose M
Dobbs Audiologist Audiology 03/21/2011John B
Dodd-WilsonEPSDT Supplemental ServicesProvider Social Work 05/02/2012Tina T
Page 97 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DodsonEPSDT Supplemental ServicesProvider Dietetics 02/01/1995Barbara E
DohleEPSDT Supplemental ServicesProvider Social Work 09/07/2007Kimberly S
Dolan Speech Therapist Speech Language Pathology 08/29/2000Kerrie D
Dominguez Physician Obstetrics and Gynecology 03/13/2008Aaron J
dominguezEPSDT Supplemental ServicesProvider Social Work 07/06/2012cindy
Dominguez Speech Therapist Speech Language Pathology 03/18/2009Gilda J
DonahueEPSDT Supplemental ServicesProvider Social Work 08/01/1994Jeanne H
DooleyEPSDT Supplemental ServicesProvider Dietetics 03/18/2004Elizabeth C
Page 98 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DoomaniEPSDT Supplemental ServicesProvider Social Work 12/20/2006Bianka
DorenfeldEPSDT Supplemental ServicesProvider Social Work 11/05/2012Susan
Dorfman Physician Pediatrics 08/28/2008Joan S
Dorfman Speech Therapist Speech Language Pathology 04/03/2008Valerie
Dorr-UyemuraEPSDT Supplemental ServicesProvider Dietetics 01/18/2012Laura A
DorseyEPSDT Supplemental ServicesProvider Social Work 09/02/2008Catherine J
DorseyEPSDT Supplemental ServicesProvider Social Work 02/20/2008Charmaine E
DoughertyEPSDT Supplemental ServicesProvider Social Work 08/30/2011Christine A
Page 99 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DouglasEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 03/17/2011Donna L
DowlingEPSDT Supplemental ServicesProvider Social Work 03/21/2006Nicole J
Downey Physical Therapist Physical Therapy 11/15/2012Lucinda R
DoyleEPSDT Supplemental ServicesProvider Dietetics 02/06/2012Molly E
Doyle Physical Therapist Physical Therapy 07/01/1998William A
DracyEPSDT Supplemental ServicesProvider Dietetics 06/08/2009Katherine E
Drejet Physician Pathology: Anatomic and Clinical 04/05/2012Anne
DrevnoEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/02/2012David
Page 100 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DriscollEPSDT Supplemental ServicesProvider Social Work 06/10/2011Alise L
DriscollEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/14/2011Heather L
Driscoll Orthotist Orthotics 06/09/2008Jessica A
Driscoll Occupational Therapist Occupational Therapy 06/28/2010Julie E
Droguett Physical Therapist Physical Therapy 09/23/2008Jacqueline
DrottarEPSDT Supplemental ServicesProvider Social Work 12/30/2005Sonya E
Drummond Occupational Therapist Occupational Therapy 08/03/2009Stephanie V
Dryden Physical Therapist Physical Therapy 05/21/2008Nicole M
Page 101 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
D'Souza Occupational Therapist Occupational Therapy 06/26/2007Vina
duEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/24/2012quoc
DuarteEPSDT Supplemental ServicesProvider Social Work 07/30/2007Lydia
Duben Occupational Therapist Occupational Therapy 02/04/2008Ora G
DuboffEPSDT Supplemental ServicesProvider Social Work 05/01/1980Jill D
Duckhorn Physical Therapist Physical Therapy 07/08/2008Gaurett B
DucksworthEPSDT Supplemental ServicesProvider Social Work 04/24/2007Heather M
DucksworthEPSDT Supplemental ServicesProvider Social Work 08/08/2006Yolanda S
Page 102 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
DuffinEPSDT Supplemental ServicesProvider Dietetics 04/03/2007Raelene
DuffinEPSDT Supplemental ServicesProvider Social Work 03/14/2011Susanne B
Duffy Physical Therapist Physical Therapy 12/01/1996Chiye O
Dulansky Occupational Therapist Occupational Therapy 05/29/2002Tamara
Dumpit Occupational Therapist Occupational Therapy 10/20/2008Melina I
DunbarEPSDT Supplemental ServicesProvider Social Work 02/13/2009Jennifer E
DunhamEPSDT Supplemental ServicesProvider Social Work 07/01/1994Heidi A
DunhamEPSDT Supplemental ServicesProvider Social Work 07/01/1994Mary
Page 103 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Dunn Speech Therapist Speech Language Pathology 07/06/2007Jeanett M
Dunne Physical Therapist Physical Therapy 09/05/2007Ray B
DuranEPSDT Supplemental ServicesProvider Social Work 06/11/2009Diane L
Durand PhysicianPediatrics: Neonatal-PerinatalMedicine 10/01/1983Manuel
Durbin Speech Therapist Speech Language Pathology 05/01/1992Christine M
DurrenbergerEPSDT Supplemental ServicesProvider Social Work 06/24/2009Dianne S
Dutrow Physical Therapist Physical Therapy 07/19/2012Samantha Diane
Dybdahl Speech Therapist Speech Language Pathology 08/21/2006Allison H
Page 104 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Dye Orthotist Orthotics 08/07/2012Melanie L
Dyer Audiologist Audiology 09/25/2009Linda K
EarlsEPSDT Supplemental ServicesProvider Social Work 06/13/2011Kelly
Eastman Physical Therapist Physical Therapy 05/01/1989E M
EastmanEPSDT Supplemental ServicesProvider Social Work 12/29/2009Malynda E
Eastman Physical Therapist Physical Therapy 05/28/2008Trisha A
EcheverriaEPSDT Supplemental ServicesProvider Social Work 10/19/2012April E
Eddington-BaileyEPSDT Supplemental ServicesProvider Social Work 05/18/2011Tracie L
Page 105 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Eddleman-RobinsonEPSDT Supplemental ServicesProvider Social Work 07/26/2001Edith
Edita Physician Pediatrics 01/12/2010Aguilar S
Edlynn Psychologist Psychology 01/28/2009Emily S
Edwards Physician Obstetrics and Gynecology 07/25/2007Katherine C
Edwards Psychologist Psychology 01/18/2008Theresa D
Edwards Physician Family Medicine 08/28/2008William M
Egbert Physical Therapist Physical Therapy 07/10/2008Susan G
Eggers Speech Therapist Speech Language Pathology 05/23/2008Erika
Page 106 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Ehat Occupational Therapist Occupational Therapy 10/13/2005Karl F
EhresmanEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 03/24/2010Katherine L
Eicholtz Speech Therapist Speech Language Pathology 01/01/1997Glenn E
Eimers Physical Therapist Physical Therapy 04/19/2012Mary K
EisenmanEPSDT Supplemental ServicesProvider Social Work 04/25/2012Elizabeth K
EisnerEPSDT Supplemental ServicesProvider Social Work 09/24/2009 09/24/2009Sabrina G
EldredEPSDT Supplemental ServicesProvider Social Work 08/29/2011Danielle B
Elevado Physician Pediatrics 11/20/2008Maria M
Page 107 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Elias Orthotist Orthotics 10/29/2004Thomas K
ElisonEPSDT Supplemental ServicesProvider Social Work 10/10/2011Kathryn C
Elliott-SistersonEPSDT Supplemental ServicesProvider Dietetics 02/01/2006Laura A
Elliston Physical Therapist Physical Therapy 03/05/2004Elizabeth A
Elwell Physical Therapist Physical Therapy 11/15/2005Holly A
elyEPSDT Supplemental ServicesProvider Social Work 07/01/1994margi
Emanuel Speech Therapist Speech Language Pathology 12/14/2006Lakieta L
Emde Occupational Therapist Occupational Therapy 09/01/2009John P
Page 108 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Endriss Physical Therapist Physical Therapy 01/15/2009Sabine
Engles Physical Therapist Physical Therapy 08/08/2011Mary
EnriquezEPSDT Supplemental ServicesProvider Social Work 08/10/2012Michelle S
EnriquezEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/03/2012Yvonne
Epstein Psychologist Psychology 09/02/2011Flavio
EricksonEPSDT Supplemental ServicesProvider Dietetics 05/01/1995Linda
Erman Speech Therapist Speech Language Pathology 09/01/1998Andrew A
ErvinEPSDT Supplemental ServicesProvider Dietetics 09/24/2012Christina M
Page 109 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
EsareyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/09/2010Shawna L
EscaleraEPSDT Supplemental ServicesProvider Social Work 04/16/2007Guadalupe P
Eskwitt Audiologist Audiology 11/24/1999Donna
Esparza-GonzalezEPSDT Supplemental ServicesProvider Social Work 02/04/2004Virginia
Espinoza Occupational Therapist Occupational Therapy 12/01/1987Angela H
Esposito Physician Family Medicine 03/22/2010Nicole
EsquiviasEPSDT Supplemental ServicesProvider Social Work 01/03/2006Silvia
EsslingEPSDT Supplemental ServicesProvider Social Work 05/09/2011Florence
Page 110 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
EstradaEPSDT Supplemental ServicesProvider Social Work 09/26/2006Cynthia E
EstradaEPSDT Supplemental ServicesProvider Social Work 03/09/2010Lucille J
EstradaEPSDT Supplemental ServicesProvider Social Work 06/11/2009Patricia E
Eugenio Physical Therapist Physical Therapy 11/01/1999Angela
EvansEPSDT Supplemental ServicesProvider Dietetics 01/31/2012Allyn E
EvansEPSDT Supplemental ServicesProvider Social Work 02/01/2007La Verne W
Evans Prosthetist Prosthetics/Orthotics 02/02/2006Matthew S
EvansEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/22/2011Stacey D
Page 111 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
EvansEPSDT Supplemental ServicesProvider Social Work 07/25/2006Virginia M
Ewell Audiologist Audiology 02/04/2011Courtney
Ewing Speech Therapist Speech Language Pathology 10/23/2009Sherry A
Fahey Occupational Therapist Occupational Therapy 02/10/2012Amy E
Falcon Occupational Therapist Occupational Therapy 01/25/2006Sophia R
Falkenberg Physical Therapist Physical Therapy 08/01/1999Stephanie L
FarabaughEPSDT Supplemental ServicesProvider Social Work 09/06/2006David P
FarabelliEPSDT Supplemental ServicesProvider Social Work 11/25/2008Jill P
Page 112 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Farell Physical Therapist Physical Therapy 12/29/2008Deena J
Farrales-NguyenEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 12/15/2000Susan
Farrell Physical Therapist Physical Therapy 08/01/2000Nancy E
FarriorEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/08/2005Sharmayne
Farris Physical Therapist Physical Therapy 12/01/1997Melaine
FarwellEPSDT Supplemental ServicesProvider Social Work 01/21/2010Karen C
Farwick Speech Therapist Speech Language Pathology 09/17/2012Ashley M
Fasnacht-Hill Psychologist Psychology 09/05/2003Lisa A
Page 113 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
FeldmanEPSDT Supplemental ServicesProvider Dietetics 06/06/2012Erin
Feldman PhysicianMedical Genetics: Clinical Genetics(M.D.) 02/17/2010Gary M
Feldman Physician Pediatrics 11/01/1979Gary M
FelkelEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/07/2012Erin K
FennelEPSDT Supplemental ServicesProvider Social Work 04/17/2009Robin P
Ferguson Speech Therapist Speech Language Pathology 03/07/2008Caroline E
Ferguson-MaharajEPSDT Supplemental ServicesProvider Dietetics 07/13/2004Nicole
FernandezEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/03/2010Christine M
Page 114 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
FernandezEPSDT Supplemental ServicesProvider Dietetics 08/23/2004Lori M
FernandezEPSDT Supplemental ServicesProvider Social Work 10/19/2011Nancy
FernandezEPSDT Supplemental ServicesProvider Social Work 06/12/2007Rowena C
Fernandez Occupational Therapist Occupational Therapy 03/08/2005Roxana C
Ferolino Physical Therapist Physical Therapy 12/10/2007Grace J
Ferrens Physical Therapist Physical Therapy 09/23/2008Melissa L
Ferri-Taylor Physical Therapist Physical Therapy 02/01/1995Brian M
Fetherston Audiologist Audiology 05/31/2002Cynthia P
Page 115 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
FetherstonEPSDT Supplemental ServicesProvider Social Work 11/05/2009Todd G
FeuryEPSDT Supplemental ServicesProvider Social Work 06/30/2011David R
Fice Physical Therapist Physical Therapy 02/04/2008Diane E
Fidler-Johnson Speech Therapist Speech Language Pathology 04/10/2009Christina
Figuered Psychologist Psychology 08/20/2009Bruce V
FigueroaEPSDT Supplemental ServicesProvider Social Work 05/10/2011Marleni
FiliciottoEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/05/2011Eileen P
Finch Physical Therapist Physical Therapy 09/22/2009Marybeth
Page 116 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Finnegan Speech Therapist Speech Language Pathology 07/16/2008Lisa R
Fiori Occupational Therapist Occupational Therapy 07/25/2005Lana L
FischerEPSDT Supplemental ServicesProvider Dietetics 03/20/2009Cynthia L
Fischer Speech Therapist Speech Language Pathology 09/28/2009Jennifer A
Fischer Physical Therapist Physical Therapy 09/16/2008Katherine A
FischerEPSDT Supplemental ServicesProvider Social Work 06/03/2008Kristen
Fischer Speech Therapist Speech Language Pathology 01/06/2011Melissa L
Fisher Orthotist Orthotics 03/08/2005Tamara D
Page 117 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Fishman Psychologist Psychology 06/24/2009Debra A
Fitchew Physical Therapist Physical Therapy 08/22/2006Amber T
Fitzgerald Speech Therapist Speech Language Pathology 10/07/2011Courtney F
Fitzpatrick Psychologist Psychology 02/21/2008Kathleen K
FlanaganEPSDT Supplemental ServicesProvider Dietetics 07/01/1996Gretchen D
Flattery Physician Internal Medicine 08/22/2012Davida
FletcherEPSDT Supplemental ServicesProvider Dietetics 01/01/2001Pauline L
Flores Occupational Therapist Occupational Therapy 07/31/2006Jennifer L
Page 118 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
FloresEPSDT Supplemental ServicesProvider Social Work 07/17/2007Kendra M
FloresEPSDT Supplemental ServicesProvider Social Work 05/19/2010Kiran
Flores Physician Family Medicine 10/06/2009Maribel C
FloresEPSDT Supplemental ServicesProvider Social Work 03/03/2011Micaela V
Foldvary Speech Therapist Speech Language Pathology 11/01/1993Sherry L
Fong Physical Therapist Physical Therapy 09/20/2005Sherina J
Fong Audiologist Audiology 03/30/2010Stacey T
Foosaner Physical Therapist Physical Therapy 04/13/2006Michelle K
Page 119 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Foote Physical Therapist Physical Therapy 10/10/2011Melissa R
Forburger Occupational Therapist Occupational Therapy 12/21/2005Anne E
Forcier Occupational Therapist Occupational Therapy 09/01/1995Michelle
ForemanEPSDT Supplemental ServicesProvider Social Work 03/16/2006Michelle
Forero Physical Therapist Physical Therapy 11/20/1989Nancy J
Forn Physical Therapist Physical Therapy 01/07/2010Shelby L
Fort Physician Pediatrics 08/01/1979Grady R
Fortini Physical Therapist Physical Therapy 08/05/2004Mary D
Page 120 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Foster Occupational Therapist Occupational Therapy 11/01/1986Kathryn M
Foster Speech Therapist Speech Language Pathology 07/11/1984Lori J
Fowler Audiologist Audiology 07/23/2009Margaret M
Fox Physician Dermatology 09/22/2006Joyce N
Fox Physical Therapist Physical Therapy 12/09/2009Kristen E
Fox-LathropEPSDT Supplemental ServicesProvider Social Work 08/08/2006Stephanie H
Francis Physical Therapist Physical Therapy 07/25/2011Ann R
Francis Physician Pediatrics 06/20/2012Devon
Page 121 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Francis Physician Pediatrics 02/01/2001Katherine
Frank Speech Therapist Speech Language Pathology 10/29/2009Melanie A
FranklinEPSDT Supplemental ServicesProvider Social Work 09/01/1991Leroy
FranklinEPSDT Supplemental ServicesProvider Social Work 10/24/2011Tonya L
FranklunEPSDT Supplemental ServicesProvider Social Work 09/01/1991Leroy
Fraser Psychologist Psychology 07/26/2005Sara
FrazierEPSDT Supplemental ServicesProvider Social Work 07/28/2006Alana
Freccero Occupational Therapist Occupational Therapy 04/24/2009Allison D
Page 122 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
FreckEPSDT Supplemental ServicesProvider Dietetics 01/01/1995Susan B
FreemaEPSDT Supplemental ServicesProvider Social Work 07/26/2010Michele
FreemanEPSDT Supplemental ServicesProvider Social Work 07/26/2010Michele
FreemanEPSDT Supplemental ServicesProvider Social Work 10/16/2007Mishanda Y
FreemanEPSDT Supplemental ServicesProvider Social Work 07/10/2003Nicole A
Freeman Psychologist Psychology 09/30/2008Stephanny F
Freire Prosthetist Prosthetics 01/01/1998Joseph A
Frese-TroopEPSDT Supplemental ServicesProvider Social Work 04/07/2008Arlene F
Page 123 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Frevert Physical Therapist Physical Therapy 10/22/2009Emily L
FriedlanderEPSDT Supplemental ServicesProvider Marriage Family Therapy 11/15/2007Elisa J
FriedmanEPSDT Supplemental ServicesProvider Social Work 11/18/2009Debbi J
FriedmanEPSDT Supplemental ServicesProvider Social Work 11/18/2009 11/18/2009Debbi J
Friedman-Bender Psychologist Psychology 07/12/2007Amy E
Friend Speech Therapist Speech Language Pathology 08/11/2011Kimberly A
Frieze Psychologist Psychology 08/18/2009Erika A
FromanEPSDT Supplemental ServicesProvider Social Work 05/01/1998Valerie A
Page 124 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Fruzza Physician Pediatrics 01/31/2011Mathew L
FuchinoEPSDT Supplemental ServicesProvider Social Work 12/29/2011Kelly K
Fuentes Physician Pediatrics 04/12/2007Jorge A
Fuentes Physical Therapist Physical Therapy 06/24/2008Oliver
FuenzalidaEPSDT Supplemental ServicesProvider Social Work 09/04/2008Evelyn P
Fujimoto PhysicianMedical Genetics: ClinicalBiochemical Genetics 11/26/2007Atsuko
Fujimoto PhysicianMedical Genetics: ClinicalCytogenetics 11/26/2007Atsuko
Fujimoto PhysicianMedical Genetics: Clinical Genetics(M.D.) 11/26/2007Atsuko
Page 125 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Fujimoto Physician Pediatrics 11/01/1972Atsuko
FukuchiEPSDT Supplemental ServicesProvider Social Work 05/21/2008Tina N
FullerEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 06/01/2000Martha G
FundakowskiEPSDT Supplemental ServicesProvider Social Work 06/08/2012David Alan
FunkeEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/20/2012Elizabeth Ann
Furgason Audiologist Audiology 12/01/2009Frances A
FurseEPSDT Supplemental ServicesProvider Social Work 04/28/2011Tanya M
Furukawa Audiologist Audiology 04/30/2007Izumi
Page 126 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
FurutaEPSDT Supplemental ServicesProvider Social Work 08/08/2006Gary R
FusaroEPSDT Supplemental ServicesProvider Social Work 04/15/2005Susan T
GaborekEPSDT Supplemental ServicesProvider Social Work 11/09/2009Janet P
Gabrielson Occupational Therapist Occupational Therapy 02/14/2011Lindsey M
GabudaoEPSDT Supplemental ServicesProvider Social Work 10/18/2007Arthur B
GallardoEPSDT Supplemental ServicesProvider Social Work 11/07/2011Patricia
GallegosEPSDT Supplemental ServicesProvider Social Work 06/09/2008Martha I
GamboaEPSDT Supplemental ServicesProvider Social Work 07/17/2007Georgina
Page 127 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Gamboa-PerezEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/29/2010Reyna V
GamundoyEPSDT Supplemental ServicesProvider Social Work 01/01/1996Don D
Ganann Speech Therapist Speech Language Pathology 04/29/2009Michelle G
Ganatra Audiologist Audiology 04/18/2005Kosha
Gang Occupational Therapist Occupational Therapy 09/15/2009Sarah A
Gangwer Speech Therapist Speech Language Pathology 06/15/2011Holly E
Gannon PhysicianPsychiatry and Neurology:Psychiatry 09/05/2012Timothy L
Gapultos Occupational Therapist Occupational Therapy 04/08/2011Desiree Mae G
Page 128 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Garbarino Speech Therapist Speech Language Pathology 07/01/1996Wendy
Garces Orthotist Orthotics 11/02/2007Carlos M
Garces Prosthetist Prosthetics 11/02/2007Carlos M
Garcia Physical Therapist Physical Therapy 08/15/2006Dina
Garcia Occupational Therapist Occupational Therapy 02/22/2012Guadalupe
GarciaEPSDT Supplemental ServicesProvider Social Work 08/15/2008Jared R
GarciaEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/03/2011Jennifer M
GarciaEPSDT Supplemental ServicesProvider Social Work 10/01/2012Jessica S
Page 129 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Garcia Occupational Therapist Occupational Therapy 04/02/2009Keri A
Garcia-MohrEPSDT Supplemental ServicesProvider Social Work 06/01/1982Mercedes
Garden Occupational Therapist Occupational Therapy 11/14/2006Cheryl
GardhouseEPSDT Supplemental ServicesProvider Dietetics 11/09/2012Valerie Jean
GardnerEPSDT Supplemental ServicesProvider Social Work 02/01/1987Pamela S
Gardner Physician Family Medicine 01/30/2012Richard L
Garfin Physical Therapist Physical Therapy 08/26/2003Jessica M
Garibaldi Prosthetist Prosthetics/Orthotics 05/18/2005Matthew G
Page 130 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
GarlitosEPSDT Supplemental ServicesProvider Dietetics 01/16/2004Susan R
GarnerEPSDT Supplemental ServicesProvider Social Work 01/17/2007Nikki L
GaroneEPSDT Supplemental ServicesProvider Dietetics 04/23/2009Cheryl M
Garretson Physician Pediatrics 08/08/2008John F
Garske Physical Therapist Physical Therapy 04/06/2009Heidi M
GarzaEPSDT Supplemental ServicesProvider Social Work 02/24/2009John T
Garza-StewartEPSDT Supplemental ServicesProvider Social Work 05/04/2007Priscilla A
Gasior Physician Family Medicine 09/11/2006Anne
Page 131 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
GastelumEPSDT Supplemental ServicesProvider Social Work 04/05/2006Claudia M
Gaylor Physical Therapist Physical Therapy 05/20/2011Charles D
GaynorEPSDT Supplemental ServicesProvider Dietetics 10/29/2010Tessa S
Gaytan Physician Pediatrics 09/26/2012Mauricio
GebremichaelEPSDT Supplemental ServicesProvider Social Work 11/29/2011Frehiwot
Gee Physical Therapist Physical Therapy 04/11/2003Richard S
GeeEPSDT Supplemental ServicesProvider Dietetics 02/15/2006Rozane M
Geoffroy Physical Therapist Physical Therapy 08/01/1977Surina
Page 132 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
GerbitzEPSDT Supplemental ServicesProvider Social Work 03/28/2008Mindy L
GerhardtEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/20/2011Holly
GerigkEPSDT Supplemental ServicesProvider Social Work 01/16/2009Jaime I
GeringerEPSDT Supplemental ServicesProvider Social Work 04/15/2005Kim A
GersonEPSDT Supplemental ServicesProvider Social Work 03/28/2006Margot J
Gese Speech Therapist Speech Language Pathology 12/01/2009Kelly L
GetchellEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 12/22/2009Darcy G
GharibianEPSDT Supplemental ServicesProvider Dietetics 10/19/2011Anahit D
Page 133 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
GhiroliEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/17/2012Maureen A
Giampaoli Occupational Therapist Occupational Therapy 10/11/2007Mirabelle
GiangerelliEPSDT Supplemental ServicesProvider Dietetics 07/03/2006Janelle
GiannettaEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/01/1993Terea A
GibsonEPSDT Supplemental ServicesProvider Dietetics 02/08/2007Elvira B
Gidding Prosthetist Prosthetics 04/07/2006Mike D
GilbaughEPSDT Supplemental ServicesProvider Dietetics 03/20/2009Andrea M
GilbertEPSDT Supplemental ServicesProvider Dietetics 01/23/2006Christine A
Page 134 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Gilbert Physical Therapist Physical Therapy 11/01/1994Rebecca
Giles Physical Therapist Physical Therapy 08/14/2007Melinda K
Gill Physician Internal Medicine 11/18/2010Kirandeep K
Gill Physician Pediatrics 11/18/2010Kirandeep K
Gill Physical Therapist Physical Therapy 10/04/2010Teresa E
GillamEPSDT Supplemental ServicesProvider Social Work 09/24/2007Catharina D
Gilman Occupational Therapist Occupational Therapy 12/07/2005Anna K
Giovacchini Speech Therapist Speech Language Pathology 09/01/2000Carol
Page 135 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Gittings Occupational Therapist Occupational Therapy 05/01/1982Cynthia
GivensEPSDT Supplemental ServicesProvider Social Work 04/05/2006Wendy O
GlanceyEPSDT Supplemental ServicesProvider Social Work 05/02/2008Patricia L
Glater Audiologist Audiology 07/11/2012Jamie
Gleason Speech Therapist Speech Language Pathology 10/18/2010Patrocina S
Gleim Physical Therapist Physical Therapy 01/01/1998Jennifer
Glenn Occupational Therapist Occupational Therapy 01/13/2009Jacquelyn C
GlessEPSDT Supplemental ServicesProvider Social Work 10/26/2012Tamera L
Page 136 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
GloverEPSDT Supplemental ServicesProvider Social Work 12/15/2006Sherry J
Gluck PhysicianPsychiatry and Neurology:Psychiatry 06/07/2012Stuart B
Go Occupational Therapist Occupational Therapy 02/22/2005Onelia T
Godinez Audiologist Audiology 09/14/2010Andres
Goering Audiologist Audiology 09/27/2012Kelli Jean
Gogal Physician Pediatrics 08/08/2006Claire
GogginEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/04/2011Jessica
GohEPSDT Supplemental ServicesProvider Social Work 06/14/2012Janelle
Page 137 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Goldberg PhysicianPsychiatry and Neurology:Neurology 08/14/2012Olga Fedin
Goldenberg Physician Pediatrics 08/04/2008Patricia L
Goldgrub Audiologist Audiology 07/02/2008Shani
GoldweberEPSDT Supplemental ServicesProvider Social Work 07/01/1995Ella
GomerEPSDT Supplemental ServicesProvider Social Work 04/03/2012Sarah M
GongEPSDT Supplemental ServicesProvider Dietetics 08/12/2008Melinda W
Goni Physician Radiology: Diagnostic 07/30/2012Michelle
GonzagoEPSDT Supplemental ServicesProvider Social Work 10/12/2005Katrina A
Page 138 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Gonzalez Physician Family Medicine 09/02/2011Anne Marie B
Gonzalez Speech Therapist Speech Language Pathology 07/18/2007Deborah
Gonzalez Physical Therapist Physical Therapy 07/24/2007Elina I
Gonzalez Psychologist Psychology 03/25/2002Fernando
GonzalezEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 06/08/2012Gloria Elizabeth
GonzalezEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 03/16/2010Marta P
GonzalezEPSDT Supplemental ServicesProvider Social Work 03/04/2009Omar
Gonzalez-Morkos Psychologist Psychology 04/29/2009Betty
Page 139 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Goo Occupational Therapist Occupational Therapy 11/17/2005Tina A
Goodfellow Occupational Therapist Occupational Therapy 05/27/2009John E
Goodfellow Speech Therapist Speech Language Pathology 10/22/2002Judy
Goodrich Occupational Therapist Occupational Therapy 11/29/2010Rachelle C
Goodson Audiologist Audiology 12/01/2006Sharon M
Gopal Physical Therapist Physical Therapy 05/01/1995Rekha
Gordon Physician Family Medicine 07/24/2009Christopher J
Gordon Psychologist Psychology 05/01/1998La Faune Y
Page 140 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Gore-Felton Psychologist Psychology 10/27/2005Cheryl E
GoshgarianEPSDT Supplemental ServicesProvider Social Work 04/15/2004Paul S
Gosiengfiao Occupational Therapist Occupational Therapy 02/17/2011Zarah L
Gossett Speech Therapist Speech Language Pathology 03/06/2008Gretchen A
GourleyEPSDT Supplemental ServicesProvider Dietetics 07/22/2008Lisa M
Gover Speech Therapist Speech Language Pathology 02/06/2006Caryn C
Gover Psychologist Psychology 06/24/2009Fredrica J
Graalman Occupational Therapist Occupational Therapy 01/30/2009Beth L
Page 141 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Gracia Audiologist Audiology 11/05/2001Gina
Gradert Physical Therapist Physical Therapy 05/01/2006Bethany E
GraffEPSDT Supplemental ServicesProvider Social Work 06/26/2003Leanne M
Graham Occupational Therapist Occupational Therapy 02/08/2007Renee M
Granado Audiologist Audiology 03/09/2010Molly H
Grant Physical Therapist Physical Therapy 05/14/2003Wendy L
Gray Psychologist Psychology 12/23/2002Christine C
GrecuEPSDT Supplemental ServicesProvider Social Work 08/04/2008Elizabeth
Page 142 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
GreenEPSDT Supplemental ServicesProvider Dietetics 06/19/2012Carole L
Green Occupational Therapist Occupational Therapy 01/23/2009Gaye
Green Physical Therapist Physical Therapy 06/01/1997Jennifer A
GreenEPSDT Supplemental ServicesProvider Social Work 06/23/2006Maiarisha I
Green Physical Therapist Physical Therapy 11/24/1999Richard A
Greenberg Occupational Therapist Occupational Therapy 02/18/2009Lynn A
Greenberg Physical Therapist Physical Therapy 11/10/2002Marcia B
GreenbergEPSDT Supplemental ServicesProvider Social Work 06/27/2006Roberta
Page 143 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Greene Physical Therapist Physical Therapy 03/17/2008Jennifer L
GreeneEPSDT Supplemental ServicesProvider Social Work 09/26/2006Joseph H
GregoryEPSDT Supplemental ServicesProvider Social Work 03/28/2006Karin D
Grennan Physician Radiology: Diagnostic 08/01/2012Jason
Griep Physical Therapist Physical Therapy 12/20/2005Jolene K
Grigoriu Physician Pediatrics 08/17/2007Paula
Grolle Physical Therapist Physical Therapy 06/01/1990Margaret
Gross Psychologist Psychology 10/16/2007Kristin
Page 144 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Grosse Physical Therapist Physical Therapy 05/01/1992Katherine M
GrossmanEPSDT Supplemental ServicesProvider Social Work 05/01/2006Jennifer R
Grotbeck Physical Therapist Physical Therapy 01/01/2001Holly
Gualeni Physical Therapist Physical Therapy 01/01/1994Gina
GuillermoEPSDT Supplemental ServicesProvider Dietetics 04/28/2009Melissa T
Guilliano Physical Therapist Physical Therapy 09/23/2003Sandra S
GuleserEPSDT Supplemental ServicesProvider Social Work 08/03/2006Beril J
Gunn Psychologist Psychology 03/23/2010Timothy E
Page 145 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Gunther Psychologist Psychology 10/12/2011Joan R
Gutcher Physical Therapist Physical Therapy 02/23/2007Linda J
GutierrezEPSDT Supplemental ServicesProvider Dietetics 05/25/2007Chessaly J
GutierrezEPSDT Supplemental ServicesProvider Social Work 02/13/2009Maria L
Gutierrez Psychologist Psychology 08/28/2008Veronica
Gutierrez Physical Therapist Physical Therapy 11/28/2006Zoe V
GuzmanEPSDT Supplemental ServicesProvider Social Work 08/09/2010Moncia I
GuzmanEPSDT Supplemental ServicesProvider Social Work 09/25/2009Vanessa R
Page 146 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
HaEPSDT Supplemental ServicesProvider Social Work 12/22/2009Carol R
HaberEPSDT Supplemental ServicesProvider Social Work 05/01/1988Debra M
Haberstock Speech Therapist Speech Language Pathology 10/27/2005Keith R
Hackman Speech Therapist Speech Language Pathology 12/14/2006Kristin P
Haga-MooreEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/02/2012Jayne B
HagerEPSDT Supplemental ServicesProvider Social Work 07/01/1999Marcia
HaggardEPSDT Supplemental ServicesProvider Social Work 01/19/2012Rena C
Hale Physical Therapist Physical Therapy 05/17/2011Jessica R
Page 147 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Hall Psychologist Psychology 10/27/2009Arthur L
Hall Speech Therapist Speech Language Pathology 01/29/2009Christie B
Hall Physical Therapist Physical Therapy 06/07/2010Elizabeth M
Hall Occupational Therapist Occupational Therapy 03/01/1998Stephanie
Hall Occupational Therapist Occupational Therapy 10/13/2005Timothy P
HallettEPSDT Supplemental ServicesProvider Social Work 09/04/2008Susan R
HalwaniEPSDT Supplemental ServicesProvider Dietetics 07/27/2007Kristina L
Hamberger Occupational Therapist Occupational Therapy 06/24/2009Robyn L
Page 148 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
HamlettEPSDT Supplemental ServicesProvider Social Work 08/01/1992Holly E
HammondEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/09/2010Jessica L
HanafusaEPSDT Supplemental ServicesProvider Social Work 07/12/2007Takako
Hand Physical Therapist Physical Therapy 09/19/2004Thomas R
Handley Physical Therapist Physical Therapy 12/12/2005Chantal A
Handojo Physician Family Medicine 07/22/2011Troy J
HankersonEPSDT Supplemental ServicesProvider Social Work 07/07/2006Bridgett
Hankin Psychologist Psychology 08/01/2008Dina C
Page 149 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Hankins Speech Therapist Speech Language Pathology 08/26/2009Abigail S
Hanley Occupational Therapist Occupational Therapy 08/01/1992Cheryl A
Hanley Occupational Therapist Occupational Therapy 04/10/2009Lydia P
Hanly Orthotist Orthotics 11/17/2008Robert J
HannerEPSDT Supplemental ServicesProvider Social Work 03/23/2004Betty L
Hansen Orthotist Orthotics 10/01/1988Deanna J
HansonEPSDT Supplemental ServicesProvider Social Work 01/01/1996Catherine D
Hanson-TimpsonEPSDT Supplemental ServicesProvider Dietetics 10/17/2007Tara A
Page 150 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
HaradaEPSDT Supplemental ServicesProvider Dietetics 01/16/2009Masako
HardcastleEPSDT Supplemental ServicesProvider Social Work 03/23/2011Amy E
HarderEPSDT Supplemental ServicesProvider Social Work 04/24/2007Rosalind H
Hardiman Physician Obstetrics and Gynecology 05/16/2007Francis X
HardyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 06/09/2010Allison R
Harner Physical Therapist Physical Therapy 08/25/2008Adam P
Harper Speech Therapist Speech Language Pathology 09/13/2010Amber L
HarrimanEPSDT Supplemental ServicesProvider Social Work 11/18/2009Eva M
Page 151 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
HarringEPSDT Supplemental ServicesProvider Social Work 03/20/2007Michelle Shelly L
Harrington Speech Therapist Speech Language Pathology 03/16/2012Bridget M
HarrisEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/13/2010Michelle R
HarrisonEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/10/2001Jeanette M
HartEPSDT Supplemental ServicesProvider Social Work 03/28/2006Morgan M
HarveyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 12/20/2011Joyce A
Harway Physician Orthopaedic Surgery 03/10/2009Robert A
HarwoodEPSDT Supplemental ServicesProvider Social Work 05/03/2010Irene
Page 152 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Hasek-Peck Physical Therapist Physical Therapy 07/07/2005Kelly
Haselrig Psychologist Psychology 03/02/2010Trina-Marie
Hatfield Physical Therapist Physical Therapy 08/29/2005Jerri K
Hausman Audiologist Audiology 11/01/1999Cheryl
HayashiEPSDT Supplemental ServicesProvider Social Work 03/23/2006Makiko
Hayes Audiologist Audiology 06/10/2002Jennifer D
Hayes Occupational Therapist Occupational Therapy 03/09/2010Stephanie J
Hayes Occupational Therapist Occupational Therapy 03/09/2010 03/09/2010Stephanie J
Page 153 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Hayes Speech Therapist Speech Language Pathology 08/01/1978Victoria
HaymonEPSDT Supplemental ServicesProvider Social Work 08/08/2006Gregory E
HaynesEPSDT Supplemental ServicesProvider Dietetics 10/13/2004Janet E
Hazboun Occupational Therapist Occupational Therapy 11/22/2010Virginia M
HeadleeEPSDT Supplemental ServicesProvider Social Work 11/16/2006Jospeh J
Heard Occupational Therapist Occupational Therapy 08/24/1981Angela M
Heermann Occupational Therapist Occupational Therapy 09/07/2007Shelley
Heffron Physical Therapist Physical Therapy 08/24/2012Kelly M
Page 154 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Heidfeld Physical Therapist Physical Therapy 06/01/2001Gabriel
HeightsEPSDT Supplemental ServicesProvider Social Work 02/13/2009Tumani N
Heiner Physician Obstetrics and Gynecology 04/27/2007Richard A
HeinonenEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/20/2009Sarah A
Heisler Occupational Therapist Occupational Therapy 11/17/2009Alicia H
Heller Speech Therapist Speech Language Pathology 05/19/2010Amy R
Helm Occupational Therapist Occupational Therapy 12/09/2008Allison G
HeltonEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/22/2010Angela C
Page 155 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Henderson Speech Therapist Speech Language Pathology 05/06/2011Juliet M
HendryEPSDT Supplemental ServicesProvider Dietetics 05/28/2008Diana L
HenryEPSDT Supplemental ServicesProvider Social Work 11/09/2010Lisa K
HenryEPSDT Supplemental ServicesProvider Social Work 09/08/2011Lori
Hensarling Audiologist Audiology 03/12/2007Emily B
HerEPSDT Supplemental ServicesProvider Social Work 01/08/2008Maiya
HerbstEPSDT Supplemental ServicesProvider Social Work 01/20/2011Marilyn S
Hermann Physician Family Medicine 02/06/2012James E
Page 156 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Hermanson Psychologist Psychology 06/01/1998Kaye
Hermes Physical Therapist Physical Therapy 09/14/2010Mary E
HernandezEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/03/2011Brenda
Hernandez Physical Therapist Physical Therapy 08/24/2010James L
HernandezEPSDT Supplemental ServicesProvider Social Work 01/23/2012Jessica
HernandezEPSDT Supplemental ServicesProvider Social Work 06/13/2011Lorelei A
HernandezEPSDT Supplemental ServicesProvider Social Work 05/01/2007Mercedes
Herr Audiologist Audiology 11/15/2011Leslie L
Page 157 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Herrera Physician Pediatrics 08/03/2007Carmen M
Herrera PhysicianPediatrics: Neonatal-PerinatalMedicine 08/03/2007Carmen M
Herrera Guerra Physician Pediatrics 04/27/2011Angel A
HerringtonEPSDT Supplemental ServicesProvider Social Work 12/13/2010Stephanie
Hershel Physical Therapist Physical Therapy 06/11/2009Sarah E
Hervey Physical Therapist Physical Therapy 06/02/2011Leean M
Hessellund Occupational Therapist Occupational Therapy 01/09/2006Karin E
Hess-WituckiEPSDT Supplemental ServicesProvider Social Work 10/01/1995Sharon
Page 158 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Hetherington Physical Therapist Physical Therapy 03/20/2009Mary J
Hexom Speech Therapist Speech Language Pathology 07/28/2009Lowell G
Hiatt Audiologist Audiology 10/01/2000Christine
Hicks Speech Therapist Speech Language Pathology 08/03/2006Deborah L
HicksEPSDT Supplemental ServicesProvider Social Work 01/16/2004Matthew R
Hiddleson Speech Therapist Speech Language Pathology 07/31/1995Kimberly J
HidlebaughEPSDT Supplemental ServicesProvider Social Work 04/11/2006Andrea S
HigginsEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/22/2011Kimberly
Page 159 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
HigginsEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/01/2005Torrey
HightEPSDT Supplemental ServicesProvider Social Work 03/14/2011Deborah
HijiEPSDT Supplemental ServicesProvider Social Work 03/17/2006Sachiyo Y
Hilario Audiologist Audiology 12/01/2009Rosa
Hilario Speech Therapist Speech Language Pathology 10/01/1996Rosa
HillEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/01/2012Laura A
HillEPSDT Supplemental ServicesProvider Social Work 08/16/2007Otishia R
Hilliard Psychologist Psychology 02/12/2004Charles L
Page 160 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Hill-PirtleEPSDT Supplemental ServicesProvider Social Work 06/01/2010Loni T
Himes Audiologist Audiology 12/10/2001Barbara
HimmelrichEPSDT Supplemental ServicesProvider Social Work 02/02/2006Sandra L
HincheyEPSDT Supplemental ServicesProvider Social Work 11/29/2007Margo L
HinkleEPSDT Supplemental ServicesProvider Social Work 01/26/2010Brendan R
Hixson Physical Therapist Physical Therapy 01/09/2007Amanda K
HoEPSDT Supplemental ServicesProvider Dietetics 06/20/2007Karen
HoffmanEPSDT Supplemental ServicesProvider Social Work 02/11/2008Johanna R
Page 161 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
HoffmanEPSDT Supplemental ServicesProvider Social Work 02/09/2007Marc O
HoffmanEPSDT Supplemental ServicesProvider Social Work 01/30/2008Virginia S
Hokama Physical Therapist Physical Therapy 03/17/2008Melissa Y
Holden Audiologist Audiology 05/10/2010Kelley
Holden Speech Therapist Speech Language Pathology 09/25/2007Mitchell J
HollersEPSDT Supplemental ServicesProvider Social Work 01/04/2012Debra A
Holley Occupational Therapist Occupational Therapy 10/25/2012Anna L
HollickEPSDT Supplemental ServicesProvider Social Work 11/17/2008Victoria M
Page 162 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Holliday Occupational Therapist Occupational Therapy 03/29/2011Rosemarie
HollingerEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 01/17/2012Fabienne S
Hollister Speech Therapist Speech Language Pathology 11/07/2008Julia E
Holloway Occupational Therapist Occupational Therapy 05/06/1982Elise M
HollowayEPSDT Supplemental ServicesProvider Social Work 07/29/2011Ian W
Holmes Physician Internal Medicine 06/12/2012 06/11/2015Seth
HoltEPSDT Supplemental ServicesProvider Dietetics 12/02/2003Monica C
Holtson Psychologist Psychology 01/19/2011Steven G
Page 163 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Holzberg Occupational Therapist Occupational Therapy 05/27/2010Emily D
Honeyman Occupational Therapist Occupational Therapy 03/10/2009Michelle M
Hook Audiologist Audiology 09/30/2011Heather K
Hoover Occupational Therapist Occupational Therapy 04/01/1992Denise
Hoover Psychologist Psychology 06/18/2009Serina L
HopkinsEPSDT Supplemental ServicesProvider Dietetics 12/08/2009Evan W
Hopkins PhysicianPsychiatry and Neurology:Psychiatry 09/19/2012Rebecca J
HoppeEPSDT Supplemental ServicesProvider Social Work 06/14/2007Dominique
Page 164 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Horn Occupational Therapist Occupational Therapy 07/03/2009Heather M
HornstromEPSDT Supplemental ServicesProvider Dietetics 07/09/2010Grete R
HosslerEPSDT Supplemental ServicesProvider Social Work 06/13/2011Jennifer L
HouserEPSDT Supplemental ServicesProvider Social Work 07/31/2012Kayla Lani
Hoveyda Physical Therapist Physical Therapy 02/06/2007Alireza
Howard Audiologist Audiology 01/16/2009Jennifer L
Howard Speech Therapist Speech Language Pathology 09/01/1982Renee L
HoyerEPSDT Supplemental ServicesProvider Dietetics 11/09/2011Christine A
Page 165 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Hsu Physical Therapist Physical Therapy 05/08/2009Jerry C
Hu Audiologist Audiology 03/02/2011Michelle S
Huang Occupational Therapist Occupational Therapy 09/19/2006Candice S
Huang Physical Therapist Physical Therapy 06/14/2004Chia George
Huang Physical Therapist Physical Therapy 09/30/2009Chun C
Huang Speech Therapist Speech Language Pathology 09/24/2009John C
HubleyEPSDT Supplemental ServicesProvider Social Work 11/01/1992David C
Hudson Physical Therapist Physical Therapy 03/06/2002Jennifer R
Page 166 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Huettel Occupational Therapist Occupational Therapy 04/08/2008Melissa C
Huffman Occupational Therapist Occupational Therapy 09/01/1993Calista E
Huggins Barker Speech Therapist Speech Language Pathology 03/01/1996Janice L
Hughes Speech Therapist Speech Language Pathology 02/01/2011Brenna L
Hughes Occupational Therapist Occupational Therapy 01/12/2005Lyndsey A
Huh Speech Therapist Speech Language Pathology 05/03/2005Jennifer
Hui Physical Therapist Physical Therapy 06/12/2007Hetty S
Hulbert Speech Therapist Speech Language Pathology 07/24/2007Amy C
Page 167 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
HullEPSDT Supplemental ServicesProvider Social Work 06/22/2012Tamzen
Hume Physical Therapist Physical Therapy 05/08/2009Kelly L
HungEPSDT Supplemental ServicesProvider Social Work 11/30/2011Emily H
HurleyEPSDT Supplemental ServicesProvider Social Work 12/18/2007James A
Huszti Psychologist Psychology 07/29/2002PhD
Hutchins Physical Therapist Physical Therapy 02/05/2005Ilene M
HutzezonEPSDT Supplemental ServicesProvider Dietetics 06/09/2008Peggy T
HuynhEPSDT Supplemental ServicesProvider Dietetics 08/05/2005Nhat-Phuong T
Page 168 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Huynh Physician Family Medicine 09/14/2011Thanh H
Hwang Physical Therapist Physical Therapy 01/09/2009Lisa A
HwangEPSDT Supplemental ServicesProvider Dietetics 01/08/2007Sophie J
hwangEPSDT Supplemental ServicesProvider Dietetics 04/12/2012virginia
Ibrahim Occupational Therapist Occupational Therapy 05/19/2009Robert N
Idlet-WhittleEPSDT Supplemental ServicesProvider Social Work 03/16/2012Nancy L
Ikeda Speech Therapist Speech Language Pathology 07/06/2011Emi M
ImayanagitaEPSDT Supplemental ServicesProvider Social Work 10/30/2012Wes
Page 169 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Inada Audiologist Audiology 03/19/2004Sharon H
IndulaEPSDT Supplemental ServicesProvider Social Work 12/21/2007Jennifer R
Inenaga Occupational Therapist Occupational Therapy 01/16/2009Eiri H
Injety Physical Therapist Physical Therapy 03/14/2004Shannon
Irizarry Physical Therapist Physical Therapy 11/13/2008Nicole M
IrwinEPSDT Supplemental ServicesProvider Social Work 11/29/2010Diane M
IsaacsEPSDT Supplemental ServicesProvider Social Work 08/17/2011Sara
Isaacson Speech Therapist Speech Language Pathology 06/27/2005Ted M
Page 170 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Italia Physical Therapist Physical Therapy 09/07/2006Abigail R
ItoEPSDT Supplemental ServicesProvider Social Work 08/07/2007Melody A
Iverson Audiologist Audiology 03/10/2010Jessica R
Ivey Physical Therapist Physical Therapy 12/13/2005Kristen D
Iyengar Physician Pediatrics 12/01/1991Radha A
IzzoEPSDT Supplemental ServicesProvider Social Work 03/23/2004Frances A
JacintoEPSDT Supplemental ServicesProvider Dietetics 01/08/2004Jaime
JackelsEPSDT Supplemental ServicesProvider Dietetics 12/12/2005Mary G
Page 171 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Jackman Physical Therapist Physical Therapy 07/21/2010Kelli T
Jackson Physician Pediatrics 12/26/2006Amanda S
JacksonEPSDT Supplemental ServicesProvider Social Work 10/12/2005Charleen D
Jackson Occupational Therapist Occupational Therapy 08/13/2008Christine D
Jackson Physician Family Medicine 02/11/2011John C
JacksonEPSDT Supplemental ServicesProvider Social Work 09/06/2006Katrice J
JacksonEPSDT Supplemental ServicesProvider Social Work 07/08/2008Kimberly E
JacksonEPSDT Supplemental ServicesProvider Social Work 10/14/2005Lisa Y
Page 172 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Jackson Psychologist Psychology 08/25/2009Tenika L
JacobsonEPSDT Supplemental ServicesProvider Social Work 07/11/2011David K
Jacobson Physician Urology 05/09/2012 05/08/2015Michael
JacobsonEPSDT Supplemental ServicesProvider Dietetics 01/04/2007Nancy A
JacobsonEPSDT Supplemental ServicesProvider Social Work 06/20/2007Nancy L
JaffeEPSDT Supplemental ServicesProvider Social Work 11/01/1995Shelly
Jaglowski Occupational Therapist Occupational Therapy 09/30/2003Joanne M
Jamali Occupational Therapist Occupational Therapy 07/08/2008Sedigheh
Page 173 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
JamesEPSDT Supplemental ServicesProvider Social Work 12/19/2011Aquilah M
James Physician Family Medicine 11/02/2011Linda E
Jang Physical Therapist Physical Therapy 12/01/2009Locke K
Jankot Occupational Therapist Occupational Therapy 10/15/2008Julia M
Jansen Occupational Therapist Occupational Therapy 05/25/2010Martinus A
JaraEPSDT Supplemental ServicesProvider Social Work 12/07/2010Erica S
Jardine Audiologist Audiology 12/17/2009Elizabeth B
JasmerEPSDT Supplemental ServicesProvider Social Work 03/30/2004Suzanne M
Page 174 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Javier Physical Therapist Physical Therapy 01/28/2010Dean
Jazayeri Physical Therapist Physical Therapy 02/01/2011Farah F
Jazayeri Physical Therapist Physical Therapy 02/01/2011Saeed
Jazi-Burke Occupational Therapist Occupational Therapy 09/14/2009Lida
JechEPSDT Supplemental ServicesProvider Social Work 10/18/2010Emil P
Jedlicka Physical Therapist Physical Therapy 11/18/2010Angelina L
Jefferies Occupational Therapist Occupational Therapy 01/12/2010Kathleen M
Jefferis Physician Internal Medicine 10/10/2012Lauren
Page 175 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Jefferis Physician Pediatrics 10/10/2012Lauren
Jeffries Speech Therapist Speech Language Pathology 10/29/2010Lavera F
Jenkins-Skelton Occupational Therapist Occupational Therapy 04/28/2010Carla E
JensenEPSDT Supplemental ServicesProvider Social Work 05/09/2011Cindy C
Jensen-AguilarEPSDT Supplemental ServicesProvider Social Work 01/19/2012Jami M
Jeon Audiologist Audiology 12/07/2010Hyunah
JimenezEPSDT Supplemental ServicesProvider Social Work 01/09/2006Juan M
JimenezEPSDT Supplemental ServicesProvider Social Work 01/17/2012Melissa E
Page 176 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
JimenezEPSDT Supplemental ServicesProvider Social Work 06/24/2008Yeymi D
Jo Psychologist Psychology 05/10/2010Mi-Yeoung
Jog Physician Internal Medicine 09/20/2012Prachi C
Jog Physician Internal Medicine: Nephrology 09/20/2012Prachi C
Johlman Speech Therapist Speech Language Pathology 11/27/2007Stacey E
JohnsEPSDT Supplemental ServicesProvider Dietetics 01/11/2006Arlene
Johnsin Speech Therapist Speech Language Pathology 11/06/2008Christy M
JohnsonEPSDT Supplemental ServicesProvider Social Work 06/08/2011Alexandra A
Page 177 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Johnson Speech Therapist Speech Language Pathology 08/06/2007April A
Johnson Psychologist Psychology 08/18/2009Arik C
JohnsonEPSDT Supplemental ServicesProvider Dietetics 02/08/2008Colleen S
JohnsonEPSDT Supplemental ServicesProvider Social Work 12/20/2006Frances B
Johnson Physician Pediatrics 06/27/2001Gina M
Johnson Physical Therapist Physical Therapy 10/30/2007Jil D
Johnson Audiologist Audiology 12/01/2008Joni L
Johnson Physical Therapist Physical Therapy 08/01/1983Linda B
Page 178 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Johnson Psychologist Psychology 07/24/2006Margaret T
Johnson Physician Radiology: Diagnostic 09/18/2012Melissa
Johnson Orthotist Orthotics 08/31/2006Ryan C
Johnston Speech Therapist Speech Language Pathology 02/22/2012Natalie S
Johnston MounierEPSDT Supplemental ServicesProvider Dietetics 06/30/2009Janet R
Jones Speech Therapist Speech Language Pathology 04/20/2010Allyson E
Jones Occupational Therapist Occupational Therapy 01/28/2011Beth E
JonesEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/14/2010Charrissa
Page 179 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Jones Physical Therapist Physical Therapy 09/12/2007Jennifer M
Jones Speech Therapist Speech Language Pathology 07/03/2008Jennifer G
JonesEPSDT Supplemental ServicesProvider Dietetics 08/07/2012Kimberly A
Jones PhysicianPsychiatry and Neurology:Neurology 09/17/2012Mark
JonesEPSDT Supplemental ServicesProvider Social Work 07/05/2006Patricia A
JonesEPSDT Supplemental ServicesProvider Social Work 01/26/2010Shirley A
Jones Audiologist Audiology 02/13/2004Stanton C
JonesEPSDT Supplemental ServicesProvider Social Work 10/16/2008Timothy R
Page 180 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Jones-Lilley Occupational Therapist Occupational Therapy 11/06/2007Sheila R
Jones-PutnamEPSDT Supplemental ServicesProvider Social Work 03/28/2006Julie G
Jorgensen Occupational Therapist Occupational Therapy 09/30/2003Elizabeth L
JoseEPSDT Supplemental ServicesProvider Social Work 04/04/2008Malia N
JosephEPSDT Supplemental ServicesProvider Social Work 08/19/2008Jordana A
Jost Physical Therapist Physical Therapy 10/27/2003Meeta B
JuarezEPSDT Supplemental ServicesProvider Dietetics 06/11/2012Amanda M
Juhan Physical Therapist Physical Therapy 08/06/2010Olga B
Page 181 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
JunEPSDT Supplemental ServicesProvider Social Work 04/25/2003Susan S
Jung Occupational Therapist Occupational Therapy 06/13/2002Joyce
Jung Physician Family Medicine 12/22/2009Kin S
Jurey Audiologist Audiology 08/02/2003Carlen E
Jurjavcic ColeEPSDT Supplemental ServicesProvider Social Work 11/04/2008Michelle C
Justiniani-AllenEPSDT Supplemental ServicesProvider Social Work 02/18/2005Jewell
JustisEPSDT Supplemental ServicesProvider Social Work 11/09/2007Sharon M
Kahrs Physical Therapist Physical Therapy 06/11/2009Amy S
Page 182 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Kaiton Physical Therapist Physical Therapy 08/24/2010Martha M
KakanEPSDT Supplemental ServicesProvider Social Work 07/02/2008Yasamin
KakdeEPSDT Supplemental ServicesProvider Dietetics 10/01/2009Jyothi
KalinyEPSDT Supplemental ServicesProvider Dietetics 09/12/2012Violette
KalmanEPSDT Supplemental ServicesProvider Social Work 02/05/2007Kathleen
Kam Physical Therapist Physical Therapy 12/01/2009Jin C
Kane Physical Therapist Physical Therapy 01/08/2008Meghan E
KangEPSDT Supplemental ServicesProvider Dietetics 11/30/2012Sun Hyung
Page 183 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
KaoEPSDT Supplemental ServicesProvider Social Work 11/09/2007Rudolf S
Kapetanovic Physical Therapist Physical Therapy 12/08/2005Alison N
Kaplan Physician Pediatrics 03/01/2005Jeffrey S
Kappelman Physical Therapist Physical Therapy 02/13/2012Lynda N
Karas Physician Anesthesiology 11/14/2011Randa F
KarimEPSDT Supplemental ServicesProvider Social Work 08/25/2010Sofia A
Karl Occupational Therapist Occupational Therapy 09/22/2010Elizabeth A
Karle Physical Therapist Physical Therapy 05/04/2011Christie D
Page 184 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
KarnouskyEPSDT Supplemental ServicesProvider Social Work 08/25/2010Elizabeth D
KarronEPSDT Supplemental ServicesProvider Social Work 04/01/2009Mindy H
Kasayama Physical Therapist Physical Therapy 10/01/2012Julie Y
Kasper Audiologist Audiology 04/08/2005Ruth H
KassorlaEPSDT Supplemental ServicesProvider Social Work 03/23/2004Alyson J
KatzEPSDT Supplemental ServicesProvider Social Work 11/06/2006Marilyn B
Kaufman Physical Therapist Physical Therapy 02/24/2012Karen M
Kay Physician Plastic Surgery 06/01/1998Susan B
Page 185 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Kazaltzes Occupational Therapist Occupational Therapy 02/02/2009Elaine
KeeEPSDT Supplemental ServicesProvider Dietetics 02/17/2006Yoon K
Keesling Audiologist Audiology 08/01/2000Julie T
Keeves Physical Therapist Physical Therapy 05/23/2008Diedre L
Keller Speech Therapist Speech Language Pathology 01/20/2010Erin E
Keller Physical Therapist Physical Therapy 09/16/2002Katherine K
Kelley Physical Therapist Physical Therapy 08/22/2006Carolyn A
Kelley Physical Therapist Physical Therapy 01/12/2009Cheryl A
Page 186 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
KelleyEPSDT Supplemental ServicesProvider Social Work 05/04/2007Erin E
KellnerEPSDT Supplemental ServicesProvider Social Work 05/15/2007Joyce N
Kelly Psychologist Psychology 11/09/2011Natalie C
Kemp-Offenberg Occupational Therapist Occupational Therapy 11/30/2006Jennifer
Kendall Occupational Therapist Occupational Therapy 05/15/2009Kimberly L
KennerlyEPSDT Supplemental ServicesProvider Dietetics 04/24/2003Tamara J
Kepes Occupational Therapist Occupational Therapy 03/01/1988Brenda N
Kern Physical Therapist Physical Therapy 01/18/2008Danelle S
Page 187 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Kern Physical Therapist Physical Therapy 10/01/1979Susan M
Kerr Speech Therapist Speech Language Pathology 01/10/2006Beverly J
KerrEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/16/2012Judith
Kerwin Audiologist Audiology 10/21/2009Chrisitna
Kesler Psychologist Psychology 12/27/2007Shelli R
KettmanEPSDT Supplemental ServicesProvider Dietetics 07/01/2011Dana K
KeyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/12/2011Christine L
KeyEPSDT Supplemental ServicesProvider Social Work 08/01/1993Jeannifer A
Page 188 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Kezele CoelhoEPSDT Supplemental ServicesProvider Dietetics 06/24/2011Michele A
Khan Physical Therapist Physical Therapy 03/16/2006Anjum H
Khan Physician Family Medicine 10/03/2011Farhat N
Khan Speech Therapist Speech Language Pathology 07/16/2009Zahid M
Khawar Physician Internal Medicine 07/26/2012Talha
Khetrapal Audiologist Audiology 05/08/2006Tara F
Kieffer Occupational Therapist Occupational Therapy 07/07/2010Amy S
Killion Occupational Therapist Occupational Therapy 02/04/2008Jill M
Page 189 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Kim Physician Pediatrics 04/29/2009Esther J
Kim Occupational Therapist Occupational Therapy 08/22/2006Gina E
KimEPSDT Supplemental ServicesProvider Social Work 03/06/2007Richard J
Kim Occupational Therapist Occupational Therapy 12/22/2008Roger K
Kimball Occupational Therapist Occupational Therapy 01/27/2003Jill M
Kime Physical Therapist Physical Therapy 01/19/2011Bradley R
King Physician Pediatrics 10/02/2008Alicia L
King Speech Therapist Speech Language Pathology 06/12/2006Jillian S
Page 190 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
KingEPSDT Supplemental ServicesProvider Social Work 08/23/2007Luvonne G
Kingsley Physician Family Medicine 03/07/2006Jolene A
Kingsley Physician Family Medicine 03/07/2006Michael C
Kirkham Audiologist Audiology 01/16/2009Pamela J
Kishimoto Occupational Therapist Occupational Therapy 03/05/2001Kristine K
Kisiday Occupational Therapist Occupational Therapy 06/06/2012Tricia E
Kitsuwa-Lowe Occupational Therapist Occupational Therapy 04/01/1982Janis
KjerEPSDT Supplemental ServicesProvider Social Work 04/17/2007Lisa M
Page 191 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
kjosnessEPSDT Supplemental ServicesProvider Social Work 07/06/2012mary
KlanieckiEPSDT Supplemental ServicesProvider Social Work 01/25/2006Cindy K
Klarich Occupational Therapist Occupational Therapy 09/05/2012Kathleen
KleinEPSDT Supplemental ServicesProvider Social Work 12/01/1994Kara B
KleinmanEPSDT Supplemental ServicesProvider Social Work 11/02/2007Laura J
KleinmanEPSDT Supplemental ServicesProvider Social Work 08/01/2006Susan M
KlierEPSDT Supplemental ServicesProvider Dietetics 11/21/2002Mary K
Klinedinst Occupational Therapist Occupational Therapy 06/09/2005Lynn D
Page 192 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
KlingerEPSDT Supplemental ServicesProvider Social Work 11/22/2006Dragana G
Klistoff Physician Family Medicine 02/11/2011Alexander J
Klus Physical Therapist Physical Therapy 06/24/2009Julie M
KnappEPSDT Supplemental ServicesProvider Social Work 11/24/2003Herschel E
KnappEPSDT Supplemental ServicesProvider Social Work 04/04/2008Janine R
Knauss Occupational Therapist Occupational Therapy 10/11/2010Elisabeth L
Knowlton Audiologist Audiology 12/03/1999Danielle M
KobylinskiEPSDT Supplemental ServicesProvider Social Work 05/24/2002Barbara A
Page 193 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
KochharEPSDT Supplemental ServicesProvider Dietetics 05/24/2005Neeta
Koebsell Audiologist Audiology 08/02/2000Katherine
KohlEPSDT Supplemental ServicesProvider Social Work 02/24/2009Aimie L
KohliEPSDT Supplemental ServicesProvider Dietetics 04/28/2011Ravina
Kohne Occupational Therapist Occupational Therapy 08/04/2009Mary B
Kokonis Audiologist Audiology 03/12/2007Marina E
Kondo Audiologist Audiology 04/18/2011Meredith C
KonethongkhamEPSDT Supplemental ServicesProvider Social Work 01/19/2012Ouraiphone
Page 194 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Korchin Occupational Therapist Occupational Therapy 08/01/1993Sharon F
Kornbluth Occupational Therapist Occupational Therapy 05/09/2006Julie B
KoskeyEPSDT Supplemental ServicesProvider Social Work 12/27/2011Hope A
KoslowskiEPSDT Supplemental ServicesProvider Social Work 08/03/2006Molly T
Kotch Physical Therapist Physical Therapy 06/15/2004Suzanne M
Kotecki Physical Therapist Physical Therapy 05/08/2009Alan F
Koustmer Occupational Therapist Occupational Therapy 03/23/2009Molly E
Kovacs Occupational Therapist Occupational Therapy 09/15/2009Robin R
Page 195 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Kramer Speech Therapist Speech Language Pathology 06/10/2011Amanda K
KramerEPSDT Supplemental ServicesProvider Social Work 01/23/2003Patricia J
Krantz Audiologist Audiology 02/25/2005Kimberly
KrauseEPSDT Supplemental ServicesProvider Dietetics 05/11/2010Leanne D
Krishan Physician Obstetrics and Gynecology 07/01/2012 06/30/2015Rachna
Krosin Physician Orthopaedic Surgery 04/11/2012 04/10/2015Michael
Krueger Psychologist Psychology 12/05/2011Casey E
Krumholz Occupational Therapist Occupational Therapy 08/13/2012Lauren E
Page 196 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ku Physician Pediatrics 07/13/2012 07/12/2015patty C
KubokawaEPSDT Supplemental ServicesProvider Dietetics 05/09/2006Jo A
Kubota Physical Therapist Physical Therapy 06/01/1986Nora
KuepferEPSDT Supplemental ServicesProvider Dietetics 02/02/2009Theresa A
Kulkarni Physician Orthopaedic Surgery 08/15/2012 08/14/2015Vedant A
Kumar Physician Internal Medicine 08/01/2012Pawan
Kumar PhysicianInternal Medicine: Endocrinology,Diabetes, and Metabolism 08/01/2012Pawan
Kundell Physician Pediatrics 08/01/1979Stephen M
Page 197 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Kunishima Physical Therapist Physical Therapy 10/28/2008Marti J
Kuo Physical Therapist Physical Therapy 12/17/2004Betty
Kuznetsov Physical Therapist Physical Therapy 12/07/2011Andriy
KvachEPSDT Supplemental ServicesProvider Dietetics 08/28/2007Yulia
Kwong Physical Therapist Physical Therapy 02/24/2012Joann T
Kylstra Physician Family Medicine 03/16/2012Trieneke
Labelle Physical Therapist Physical Therapy 04/13/2000Ted J
La Cross Physical Therapist Physical Therapy 04/23/2009Jennifer C
Page 198 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Laliberte Physical Therapist Physical Therapy 07/24/2007Paul C
Lam Physical Therapist Physical Therapy 03/09/2011Amanda C
LamEPSDT Supplemental ServicesProvider Social Work 02/01/1973Cecilia K
Lam Speech Therapist Speech Language Pathology 02/27/2007Hazel P
LamEPSDT Supplemental ServicesProvider Social Work 08/21/2007Lana
Lamb Speech Therapist Speech Language Pathology 10/14/2005Margaret A
Lamberson Physical Therapist Physical Therapy 03/27/2007Susan J
Lambing Occupational Therapist Occupational Therapy 09/29/2008Melissa
Page 199 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
La More Audiologist Audiology 04/26/2011Carissa R
LandellsEPSDT Supplemental ServicesProvider Social Work 12/12/2007Ellen M
Landini Occupational Therapist Occupational Therapy 02/22/2008Margaret J
Landless Occupational Therapist Occupational Therapy 08/17/2007Jill G
LandmannEPSDT Supplemental ServicesProvider Social Work 01/08/2008Sara E
LaneEPSDT Supplemental ServicesProvider Social Work 11/10/2009Priscilla S
LanflisiEPSDT Supplemental ServicesProvider Social Work 07/07/2006Kathryn M
LangEPSDT Supplemental ServicesProvider Dietetics 12/03/2007Bradley C
Page 200 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
LarazoloEPSDT Supplemental ServicesProvider Social Work 06/08/2009Gaspar G
LardizabalEPSDT Supplemental ServicesProvider Social Work 03/20/2007Merci L
LaroseEPSDT Supplemental ServicesProvider Dietetics 12/15/2009Emily A
Larson Physical Therapist Physical Therapy 08/01/1978Elaine
LarsonEPSDT Supplemental ServicesProvider Social Work 07/28/2010Rikki R
Lash Speech Therapist Speech Language Pathology 05/22/2009Kimberly M
LaterzaEPSDT Supplemental ServicesProvider Social Work 08/18/2006Lawrence D
LathamEPSDT Supplemental ServicesProvider Dietetics 12/12/2008Susan B
Page 201 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
LaTrayEPSDT Supplemental ServicesProvider Dietetics 10/27/2008Allison E
Latta PhysicianPediatrics: Neonatal-PerinatalMedicine 05/22/2007George H
LauEPSDT Supplemental ServicesProvider Dietetics 08/20/2012Ka
LaubbacherEPSDT Supplemental ServicesProvider Social Work 12/29/2009Sarah R
Lauer Occupational Therapist Occupational Therapy 09/03/2003Janel
Lauridson Speech Therapist Speech Language Pathology 04/20/2007Sarah E
Lavelle Occupational Therapist Occupational Therapy 09/19/2006Kristin C
LaverneEPSDT Supplemental ServicesProvider Social Work 01/11/2011Dana R
Page 202 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
LawlerEPSDT Supplemental ServicesProvider Social Work 04/03/2006Laurel L
LawlerEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/28/2011Rachel L
Lawrence Physical Therapist Physical Therapy 05/18/2010Serena G
Lawton Physical Therapist Physical Therapy 01/03/2008Jeanette L
LaymanEPSDT Supplemental ServicesProvider Social Work 11/04/2008Andrew F
LazarEPSDT Supplemental ServicesProvider Dietetics 11/09/2012Sharona Chaya
Le PhysicianPsychiatry and Neurology:Psychiatry 07/25/2012Cindy
LeEPSDT Supplemental ServicesProvider Dietetics 08/01/2011Patricia G
Page 203 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Leach Physical Therapist Physical Therapy 11/26/2008Jamie L
Learned Physical Therapist Physical Therapy 05/08/2009Suzanne M
LeathamEPSDT Supplemental ServicesProvider Dietetics 12/01/2009Mildred K
Leavitt Occupational Therapist Occupational Therapy 09/01/2006Catherine
Lebby Psychologist Psychology 10/01/1997Paul
LeeEPSDT Supplemental ServicesProvider Social Work 05/18/2010Angela Y
LeeEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 06/06/2011Donna W
LeeEPSDT Supplemental ServicesProvider Dietetics 02/08/2011Dorthy L
Page 204 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Lee Speech Therapist Speech Language Pathology 10/04/2005Erika N
Lee PhysicianPsychiatry and Neurology:Neurology 03/10/2009Henry
Lee Audiologist Audiology 02/19/2008Jae-Kyung
LeeEPSDT Supplemental ServicesProvider Dietetics 01/26/2012Kathleen M
Lee Occupational Therapist Occupational Therapy 10/06/2009Leslie K
Lee Speech Therapist Speech Language Pathology 10/31/2011Natalie N
Lee Physical Therapist Physical Therapy 12/22/2009Sally Y
LeeEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/01/2010Sheryl Lee
Page 205 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Lee Audiologist Audiology 07/30/2008Soo Mei
Lee Occupational Therapist Occupational Therapy 11/08/2007Wendi K
Lee Occupational Therapist Occupational Therapy 05/18/2010Wendy
Leech Speech Therapist Speech Language Pathology 01/31/2011Taylor M
Leedy Physical Therapist Physical Therapy 07/31/2000Sandra W
LeerEPSDT Supplemental ServicesProvider Social Work 06/05/2007Samuel E
Lefkowitz Psychologist Psychology 05/28/2008Emily S
Leftwich Occupational Therapist Occupational Therapy 11/07/2011Lisa A
Page 206 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Lehman Physician Internal Medicine 03/06/2006Aaron M
Lehmann Speech Therapist Speech Language Pathology 03/08/2010Angela K
Leifer Psychologist Psychology 07/26/2001Errol F
Le Lekas Occupational Therapist Occupational Therapy 10/30/2009Tina T
LemusEPSDT Supplemental ServicesProvider Social Work 11/18/2008Berenise
LendrumEPSDT Supplemental ServicesProvider Social Work 06/11/2009Margaret A
Lennan-Smith Occupational Therapist Occupational Therapy 08/01/1992Susan
LeonardEPSDT Supplemental ServicesProvider Social Work 02/18/2009Kimberly J
Page 207 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Leong Physical Therapist Physical Therapy 03/11/2008Laurie A
LeongEPSDT Supplemental ServicesProvider Dietetics 11/29/2011Pauline P
Leon-Mondragon Physician Family Medicine 10/06/2009Michelle
LePhanEPSDT Supplemental ServicesProvider Social Work 01/13/2012Jessica L
LeporeEPSDT Supplemental ServicesProvider Social Work 09/02/2008Lynne M
Lerman Physician Orthopaedic Surgery 03/28/2002Joel A
Lerner Audiologist Audiology 11/19/2007Randy E
LeszczynskaEPSDT Supplemental ServicesProvider Social Work 05/13/2005Ursula
Page 208 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Letiecq Audiologist Audiology 02/06/2001Nicole
Lett Psychologist Psychology 05/01/2007Heather S
Leung Physical Therapist Physical Therapy 04/30/2007Kuk
LeungEPSDT Supplemental ServicesProvider Dietetics 09/15/2008Rita Y
LeungEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 06/04/2012Wendy
LevoyEPSDT Supplemental ServicesProvider Social Work 02/17/2006Debra B
Levy Psychologist Psychology 10/14/2009Samantha R
LewinEPSDT Supplemental ServicesProvider Social Work 06/21/2010Leilah S
Page 209 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
LeWinterEPSDT Supplemental ServicesProvider Social Work 08/01/2011Tovah
LewisEPSDT Supplemental ServicesProvider Social Work 03/01/1998Bonnie O
Lewis Audiologist Audiology 07/08/2009Christine R
Lewis Audiologist Audiology 01/25/2011Rebecca L
LewisEPSDT Supplemental ServicesProvider Dietetics 02/09/2006Samiya M
Lewis Occupational Therapist Occupational Therapy 05/19/2009Sandra R
Lewis Speech Therapist Speech Language Pathology 01/03/2006Shunnae A
LiangEPSDT Supplemental ServicesProvider Dietetics 01/22/2007Ella Y
Page 210 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Liang Physician Family Medicine 08/11/2009James Z
Libow Psychologist Psychology 11/01/1980Judith A
Lief Occupational Therapist Occupational Therapy 09/21/2009Anna L
Li Jimenez Physician Pediatrics 07/06/2011Rafael E
Lim Occupational Therapist Occupational Therapy 02/09/2012Audrey N
Lim Respiratory Care Practitioner Respiratory Care Practice 05/10/2012Bo
LimEPSDT Supplemental ServicesProvider Social Work 04/01/2009Hestia Y
Lin Audiologist Audiology 04/10/2006Adam
Page 211 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
LinEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 06/02/2010Aileen
LinEPSDT Supplemental ServicesProvider Dietetics 11/06/2009Angela Y
Lin Audiologist Audiology 03/15/2004Lisa C
Linbad Physical Therapist Physical Therapy 03/20/2008Ralph R
Lingad Physical Therapist Physical Therapy 03/20/2008Ralph
Linh Occupational Therapist Occupational Therapy 10/04/2010Mary Ann
Lins Physician Pediatrics 01/18/2005Max R
LinscheidEPSDT Supplemental ServicesProvider Social Work 02/01/2007Donald A
Page 212 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Lipp Occupational Therapist Occupational Therapy 10/19/2006Dianne B
Liriano Psychologist Psychology 12/05/2007Dorcas E
LitesEPSDT Supplemental ServicesProvider Dietetics 10/06/2009Michele D
Little Physician Family Medicine 07/02/2010Paul M
Liu Physician Internal Medicine 06/14/2012Benny
Liu Physician Internal Medicine: Gastroenterology 06/14/2012Benny
Liu Physician Pediatrics 01/23/2009Helen L
Liu Speech Therapist Speech Language Pathology 09/22/2009Hsing-Yi
Page 213 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Liu Physician Pediatrics 08/06/1999Katrina R
Liu Physician Ophthalmology 08/28/2012 08/27/2015Margaret
LiuEPSDT Supplemental ServicesProvider Social Work 08/23/2007Maria
LivingstonEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/04/2011Katherine K
Llewelyn Speech Therapist Speech Language Pathology 06/01/1994Deobrah D
LoEPSDT Supplemental ServicesProvider Social Work 02/01/2007Howard
Lobo PhysicianPreventive Medicine: Public Healthand General 05/10/2012Kristin
Lockwitz Speech Therapist Speech Language Pathology 12/29/2008Susan Y
Page 214 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
LoewenbeinEPSDT Supplemental ServicesProvider Social Work 06/12/2012Sharon
Lone ChiefEPSDT Supplemental ServicesProvider Social Work 03/02/2010Quizada A
Long Audiologist Audiology 09/10/2007Kelly M
LopezEPSDT Supplemental ServicesProvider Social Work 04/13/2010Flor A
Lopez Occupational Therapist Occupational Therapy 05/19/2009Mayra
LopezEPSDT Supplemental ServicesProvider Social Work 01/06/2012Melissa
Lopez Speech Therapist Speech Language Pathology 02/01/2010Norma A
Lorant Physician Plastic Surgery 09/01/1997John A
Page 215 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
LordEPSDT Supplemental ServicesProvider Social Work 08/13/2012Vaughn E
LorenzanaEPSDT Supplemental ServicesProvider Social Work 01/20/2010Jason B
Lorenzo Speech Therapist Speech Language Pathology 09/21/2010Courtney D
LouieEPSDT Supplemental ServicesProvider Dietetics 05/25/2007Suzie S
Love Occupational Therapist Occupational Therapy 11/09/2010Lisa R
LovelaceEPSDT Supplemental ServicesProvider Social Work 12/03/2009George E
Lovelace-GreenEPSDT Supplemental ServicesProvider Social Work 04/12/2000Lesley E
LovellEPSDT Supplemental ServicesProvider Social Work 10/07/2008Jayne A
Page 216 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Low Speech Therapist Speech Language Pathology 07/02/2008Karen L
LowEPSDT Supplemental ServicesProvider Dietetics 10/21/2008Stephanie S
Lowas-Roberts Audiologist Audiology 05/31/2002Tara R
LowellEPSDT Supplemental ServicesProvider Social Work 03/01/1984Janet B
LoydEPSDT Supplemental ServicesProvider Social Work 06/27/2012Melissa Jane
Lozano Prosthetist Prosthetics 03/04/2008Michael R
Luangphaxay Physician Pediatrics 10/02/2007Vongpheth
LuceroEPSDT Supplemental ServicesProvider Social Work 08/07/2007Monica C
Page 217 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
LucianoEPSDT Supplemental ServicesProvider Social Work 12/31/2009Shelley A
Lueder Respiratory Care Practitioner Respiratory Care Practice 02/09/2012Donna
LuedersEPSDT Supplemental ServicesProvider Dietetics 03/24/2006Sarah M
LukEPSDT Supplemental ServicesProvider Social Work 09/01/2011Maria C
Lukasik Psychologist Psychology 05/15/2003Meghan K
Lukens Physician Family Medicine 06/20/2011John
Luna Occupational Therapist Occupational Therapy 10/22/2009Kari A
LunaEPSDT Supplemental ServicesProvider Dietetics 04/15/2002Leslie
Page 218 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Luong Physician Pediatrics 12/19/2011Holly M
Luong Physician Pediatrics 07/14/2011Quan T
LuongEPSDT Supplemental ServicesProvider Social Work 04/17/2006Tracy H
LuprioreEPSDT Supplemental ServicesProvider Dietetics 12/01/2008Elizabeth H
Luschwitz Physician Pediatrics 02/01/2008Brian S
LynchEPSDT Supplemental ServicesProvider Dietetics 02/05/2009Kathleen M
LyndEPSDT Supplemental ServicesProvider Social Work 01/01/1996Chrisy A
Lynn Occupational Therapist Occupational Therapy 09/23/2008Amy B
Page 219 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Lynn Physician Pediatrics 09/03/2008John G
MaEPSDT Supplemental ServicesProvider Social Work 02/19/2008Stacy Nhi B
Macasinag Physician Pediatrics 01/06/2006Nanette M
MachelEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 03/14/2011Michele D
MaciasEPSDT Supplemental ServicesProvider Social Work 03/21/2006Steven
MacielEPSDT Supplemental ServicesProvider Social Work 03/02/2007Gabriela D
MackEPSDT Supplemental ServicesProvider Dietetics 07/14/2003Amy K
Mackinnon Physical Therapist Physical Therapy 01/01/1994Vicky
Page 220 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MacmahonEPSDT Supplemental ServicesProvider Dietetics 01/23/2006Allora P
Macy-HurleyEPSDT Supplemental ServicesProvider Social Work 01/17/2008Valerie
MaddoxEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/15/2012Brandi
MaderaEPSDT Supplemental ServicesProvider Social Work 04/21/2011Eiden M
MadorEPSDT Supplemental ServicesProvider Social Work 01/20/2011Charles R
MadrenEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/22/2011Chrystal M
MaelEPSDT Supplemental ServicesProvider Social Work 05/01/1994Beth J
MaguireEPSDT Supplemental ServicesProvider Social Work 11/12/2008Catherine L
Page 221 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Mahaffie Audiologist Audiology 08/04/1999Catherine J
MaierEPSDT Supplemental ServicesProvider Social Work 11/19/2009Emily L
Maierle Audiologist Audiology 10/06/2008Erin E
MaitlenEPSDT Supplemental ServicesProvider Dietetics 10/15/2009Carly D
Makarian Physical Therapist Physical Therapy 01/17/2007Teni
Makeig Audiologist Audiology 09/10/2007Heidi K
MalaveEPSDT Supplemental ServicesProvider Social Work 02/04/2011Courtney C
Malaver Speech Therapist Speech Language Pathology 02/14/2007Syndy N
Page 222 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MaldonadoEPSDT Supplemental ServicesProvider Social Work 05/20/2011Katie E
MalekEPSDT Supplemental ServicesProvider Social Work 08/01/1995Diane M
Malek Physician Anesthesiology 04/10/2012Sabri
Malilay Physical Therapist Physical Therapy 11/28/2006Maria Concepcion
Malkovich Audiologist Audiology 10/10/2007Jennifer S
Mallo Physician Family Medicine 07/29/2011Vanessa L
Malott Occupational Therapist Occupational Therapy 03/30/2007Lindy J
Manalo-Brosas Physical Therapist Physical Therapy 02/09/2007Sherine M
Page 223 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Manavi Physician Family Medicine 08/23/2011Sepehr J
ManchandraEPSDT Supplemental ServicesProvider Dietetics 04/24/2009Denise Y
MandayamEPSDT Supplemental ServicesProvider Social Work 01/18/2002Geetha
Mangondato Physician Pediatrics 05/12/2005Jussein R
Maniacop Occupational Therapist Occupational Therapy 08/08/2007Amie A
Maniar Physical Therapist Physical Therapy 09/06/2007Pooja R
MannEPSDT Supplemental ServicesProvider Social Work 11/29/2010Jasvinder K
Manna Audiologist Audiology 09/02/2004Karen L
Page 224 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Mano Physical Therapist Physical Therapy 04/03/2007Teresa L
Marais Occupational Therapist Occupational Therapy 06/25/2003Avril G
MarantoEPSDT Supplemental ServicesProvider Social Work 03/28/2006Jutta A
Marchetti Physical Therapist Physical Therapy 03/23/2001Michelle
MarciszEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/27/2010Colleen N
Marco-DashEPSDT Supplemental ServicesProvider Social Work 03/19/2007Tzipora F
Marculescu Audiologist Audiology 07/09/2007Rebecca L
Marcus PhysicianPsychiatry and Neurology:Psychiatry 05/30/2012Karen
Page 225 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MarinEPSDT Supplemental ServicesProvider Social Work 05/13/2008George
MarinceEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/29/2011Holly M
Marini-LiebenEPSDT Supplemental ServicesProvider Social Work 10/15/2012Karina W
MarinoEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/16/2012Deborah
Markel Psychologist Psychology 04/23/2009Nancy E
MarkhamEPSDT Supplemental ServicesProvider Social Work 08/28/2002Linda
MarkovichEPSDT Supplemental ServicesProvider Social Work 08/09/2010Wendy
MarksEPSDT Supplemental ServicesProvider Social Work 01/27/2009Kerri-Lee
Page 226 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Marmolejo Physical Therapist Physical Therapy 04/01/2008Donna I
Marnella Physical Therapist Physical Therapy 08/01/1979Ron J
Marques Psychologist Psychology 02/06/2012Diane
MarshallEPSDT Supplemental ServicesProvider Social Work 10/26/2010Michelle D
MartellEPSDT Supplemental ServicesProvider Social Work 01/20/2011Laurie J
Marten Speech Therapist Speech Language Pathology 10/24/2002Christine
Martin Occupational Therapist Occupational Therapy 06/01/1999Diana M
Martin Audiologist Audiology 07/29/2011Douglas R
Page 227 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Martin Physical Therapist Physical Therapy 10/30/2007Lisa K
Martin Speech Therapist Speech Language Pathology 09/12/2011Wendolyn H
MartindaleEPSDT Supplemental ServicesProvider Social Work 02/13/2009Katherine M
MartinezEPSDT Supplemental ServicesProvider Social Work 06/01/2001Araceli
Martinez Physician Pediatrics 05/17/2010Jennifer
MartinezEPSDT Supplemental ServicesProvider Social Work 02/27/2012Nancy
Martinez Audiologist Audiology 10/05/2000Stephen
MartinezEPSDT Supplemental ServicesProvider Social Work 08/25/2006Susan R
Page 228 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Martinez-MueggeEPSDT Supplemental ServicesProvider Social Work 09/01/1994Bernadette
Martinez-Savage Physical Therapist Physical Therapy 04/05/2010Marcee
Martino Occupational Therapist Occupational Therapy 11/09/2007Jesica J
Marzouk Rochverger Audiologist Audiology 11/29/2004Ilanit
MasocolEPSDT Supplemental ServicesProvider Social Work 10/01/1994Concepcion C
Masuda Occupational Therapist Occupational Therapy 05/25/2006Yoko
Masutomi Physical Therapist Physical Therapy 09/19/2006Jill S
MataEPSDT Supplemental ServicesProvider Social Work 12/15/2011Mabel S
Page 229 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Mather Occupational Therapist Occupational Therapy 11/22/2006Linda K
Mather Occupational Therapist Occupational Therapy 09/01/2006Mark H
MathewsEPSDT Supplemental ServicesProvider Social Work 07/27/2007Ann L
MathewsEPSDT Supplemental ServicesProvider Social Work 02/14/2008Stephanie S
Matkovich Physical Therapist Physical Therapy 02/23/2010Jacklin P
Matos Physical Therapist Physical Therapy 08/20/2008Rosemary F
Matson Physician Anesthesiology 09/12/2011Michael D
Matson Physician Pediatrics 09/12/2011Michael D
Page 230 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MatsunoEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 01/05/2012Tami A
MatthewsEPSDT Supplemental ServicesProvider Social Work 09/09/2008Karen L
MatthiesenEPSDT Supplemental ServicesProvider Social Work 04/01/2011Saira A
Mattson Physical Therapist Physical Therapy 11/01/1984Melodie
MaurizEPSDT Supplemental ServicesProvider Social Work 12/20/2010Carlos A
MaxwellEPSDT Supplemental ServicesProvider Social Work 09/12/2008Allison G
May Speech Therapist Speech Language Pathology 07/18/2012Ryan M
May Audiologist Audiology 05/09/2007Suzanne N
Page 231 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MayoEPSDT Supplemental ServicesProvider Social Work 12/01/1989Michael E
MaziekEPSDT Supplemental ServicesProvider Social Work 01/18/2006Jennifer D
Mazzeo Occupational Therapist Occupational Therapy 08/29/2003Ann
McAdamEPSDT Supplemental ServicesProvider Dietetics 08/05/2010Kimi G
McAlmondEPSDT Supplemental ServicesProvider Dietetics 01/09/2012Jennifer L
McAloon Physical Therapist Physical Therapy 10/20/2005Amanda J
McCartEPSDT Supplemental ServicesProvider Social Work 01/26/2012Nancy
McCarthy Occupational Therapist Occupational Therapy 02/06/2008Kimberly A
Page 232 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
McCarthy Speech Therapist Speech Language Pathology 08/31/2011Tammy D
McChesney Physical Therapist Physical Therapy 12/13/2006Gillian M
McClay Psychologist Psychology 03/11/2009Jane E
McCloskeyEPSDT Supplemental ServicesProvider Social Work 05/02/2008Sally C
McCluskey Occupational Therapist Occupational Therapy 08/13/2008Diane C
McCord Physical Therapist Physical Therapy 06/01/1995Karen J
McCormick Speech Therapist Speech Language Pathology 02/22/2012Suzanne
McCreeshEPSDT Supplemental ServicesProvider Social Work 12/20/2006Eileen M
Page 233 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
McCroskeyEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/07/2007Erin S
McCunn Speech Therapist Speech Language Pathology 08/12/2008Martha J
McCurdy Speech Therapist Speech Language Pathology 07/27/2010Jamie L
McCurdy Speech Therapist Speech Language Pathology 01/23/2008Lori A
McDanielEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/29/2010Allyson M
McDaniel Podiatrist Podiatry 12/13/2004Lauri L
McDaniel Physical Therapist Physical Therapy 05/08/2009Lona M
McDermottEPSDT Supplemental ServicesProvider Dietetics 02/14/2011Katherine A
Page 234 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
McDonald Occupational Therapist Occupational Therapy 05/19/2009Todd A
McFarlandEPSDT Supplemental ServicesProvider Dietetics 02/06/2007Carrie L
McFarland Occupational Therapist Occupational Therapy 01/29/2008Kate A
McGillivrayEPSDT Supplemental ServicesProvider Social Work 02/26/2008Brett A
McGowanEPSDT Supplemental ServicesProvider Social Work 07/28/2008William C
McInally Speech Therapist Speech Language Pathology 01/09/2012Lynn T
McIntyreEPSDT Supplemental ServicesProvider Social Work 06/29/2009Nicole M
McKenna Physician Pediatrics 06/01/1988Susan
Page 235 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Mc Keown Speech Therapist Speech Language Pathology 07/01/1996Maureen T
McKinney Physician Family Medicine 07/29/2010Cynthia
McLean Occupational Therapist Occupational Therapy 01/04/2007Jennifer
McMahan Audiologist Audiology 08/12/2011Lindsey R
Mc Mahon Physical Therapist Physical Therapy 10/01/1997Susan
McMains Physical Therapist Physical Therapy 03/01/2010Terri A
McMillanEPSDT Supplemental ServicesProvider Dietetics 12/25/2005Elizabeth B
McMills Prosthetist Prosthetics/Orthotics 07/08/2009Barry W
Page 236 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
McMullen Physical Therapist Physical Therapy 12/05/2006Joanna M
McNeal Speech Therapist Speech Language Pathology 02/03/2009Patricia A
McNelis Physical Therapist Physical Therapy 02/10/2012Alice M
McPherson Audiologist Audiology 02/18/2000Larry
McShane Speech Therapist Speech Language Pathology 01/25/2006Mary K
McVey Psychologist Psychology 01/27/2012Patricia
MeadEPSDT Supplemental ServicesProvider Social Work 09/29/2005Elizabeth D
Mead Physical Therapist Physical Therapy 07/21/2009Revay L
Page 237 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MeadowEPSDT Supplemental ServicesProvider Dietetics 02/15/2006Nicole D
Meagher Physical Therapist Physical Therapy 02/06/2006Mindy B
Medina Speech Therapist Speech Language Pathology 04/15/2009Eileen V
Medina Occupational Therapist Occupational Therapy 02/29/2012Patricia R
Medlin Physical Therapist Physical Therapy 10/07/2002Scott A
MedoroEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/25/2012Millie
Meehan Physical Therapist Physical Therapy 03/27/2007Elena F
Meehan Physician Family Medicine 03/30/2006John
Page 238 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MeeksEPSDT Supplemental ServicesProvider Social Work 10/17/2006Cynthia K
MegelEPSDT Supplemental ServicesProvider Dietetics 08/11/2009Andrea R
Mehr Occupational Therapist Occupational Therapy 11/21/2003Elizabeth A
Mehretab-Roman Physician Pediatrics 05/16/2006Yohanna A
Mehta Speech Therapist Speech Language Pathology 10/24/2005Payal H
Meier Physician Pediatrics 12/07/2012Kathryn Beaufort
MeierEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/14/2011Mahrenya J
MejiaEPSDT Supplemental ServicesProvider Social Work 08/15/2012Elizabeth
Page 239 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MejiaEPSDT Supplemental ServicesProvider Social Work 10/18/2007Silvia
MejiaEPSDT Supplemental ServicesProvider Social Work 02/28/2011William D
Melendez Occupational Therapist Occupational Therapy 07/07/2011Diana E
Melendez Physician Pediatrics 11/06/2007Michelle L
MelnickEPSDT Supplemental ServicesProvider Social Work 12/26/2002Marci B
Melton Physical Therapist Physical Therapy 09/23/2004Valerie
Melville Speech Therapist Speech Language Pathology 01/21/2011Dorthea E
Memarzadeh Physician Anesthesiology 03/16/2010Mehdi
Page 240 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Mena Audiologist Audiology 10/28/2011Victoria P
MendezEPSDT Supplemental ServicesProvider Social Work 01/26/2010Danielle M
MendozaEPSDT Supplemental ServicesProvider Social Work 05/07/2008Laura F
MendozaEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/12/2011Leticia B
MensalvasEPSDT Supplemental ServicesProvider Social Work 03/28/2006Victoria R
MenzerEPSDT Supplemental ServicesProvider Social Work 02/06/2004Erica N
MercadanteEPSDT Supplemental ServicesProvider Social Work 03/01/1992Thomas J
MercadoEPSDT Supplemental ServicesProvider Social Work 12/23/2011Rebecca
Page 241 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Mercer Speech Therapist Speech Language Pathology 08/04/2009Mary J
Merchant Physical Therapist Physical Therapy 05/23/2006Sucheeta S
Merchant Physical Therapist Physical Therapy 10/15/2008Teresa L
Meredith-DennisEPSDT Supplemental ServicesProvider Dietetics 04/25/2001Laura M
MeroeEPSDT Supplemental ServicesProvider Social Work 03/16/2012Maudisa M
Merrill Physical Therapist Physical Therapy 12/28/2005Peggy M
Merritt Prosthetist Prosthetics/Orthotics 04/11/2011Ronald P
MerriweatherEPSDT Supplemental ServicesProvider Social Work 05/01/1995Frances
Page 242 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MesavageEPSDT Supplemental ServicesProvider Social Work 11/24/2003Catherine L
Metter Physician Pediatrics 05/16/2012Debra
MetzEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/12/2011Jacalyn
MetzEPSDT Supplemental ServicesProvider Dietetics 06/08/2011Natalie C
Meyer Speech Therapist Speech Language Pathology 10/12/2005Amy E
MeysenburgEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/18/2005Sarah
Michaels Audiologist Audiology 07/19/2010Keith P
MickleEPSDT Supplemental ServicesProvider Social Work 10/25/2006Courtney A
Page 243 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MignanoEPSDT Supplemental ServicesProvider Dietetics 01/01/2001Mary
Miklowitz Psychologist Psychology 08/18/2009David J
Milan-AglugubEPSDT Supplemental ServicesProvider Dietetics 02/06/2012Benilda A
MillerEPSDT Supplemental ServicesProvider Social Work 01/03/2004Amy E
Miller Speech Therapist Speech Language Pathology 06/17/2004Amy C
MillerEPSDT Supplemental ServicesProvider Social Work 11/27/2007Catherine A
MillerEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/23/2010Claudia M
Miller Physical Therapist Physical Therapy 01/17/2012Kealoha A
Page 244 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MillerEPSDT Supplemental ServicesProvider Dietetics 12/01/1995Lisa A
MillerEPSDT Supplemental ServicesProvider Social Work 01/20/2011Michelle
MillerEPSDT Supplemental ServicesProvider Dietetics 01/14/2008Rachel J
Miller Occupational Therapist Occupational Therapy 05/17/2004Raeanne
MillerEPSDT Supplemental ServicesProvider Dietetics 05/22/2006Sandra N
Miller Speech Therapist Speech Language Pathology 10/22/1985Sara
MilotichEPSDT Supplemental ServicesProvider Dietetics 03/26/2008Catherine A
Minerley Speech Therapist Speech Language Pathology 11/01/2007Kimberly M
Page 245 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Mink-Goldrich Occupational Therapist Occupational Therapy 05/01/1997Andrea
Minor Physical Therapist Physical Therapy 12/31/2002Kathleen E
Minter Physical Therapist Physical Therapy 09/14/2011Deborah
Mintz Audiologist Audiology 06/11/2008Sandra L
MiramonEPSDT Supplemental ServicesProvider Dietetics 12/28/2005Ana G
Misner Physician Pediatrics 07/18/2011Matthew R
Mistretta Physical Therapist Physical Therapy 04/16/2008Nicole M
Mistry Occupational Therapist Occupational Therapy 02/26/2008Shiboni S
Page 246 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Mitchell Occupational Therapist Occupational Therapy 05/16/2011Jeffrey D
Mitchell Physician Family Medicine 06/22/2007Robert K
Mitchell Audiologist Audiology 12/03/1999Terry
Mizuhara Occupational Therapist Occupational Therapy 09/03/2008Jamie H
Mobley Physical Therapist Physical Therapy 02/24/2012Megan C
Mody Physician Pediatrics 01/19/2012Priya V
MojyEPSDT Supplemental ServicesProvider Dietetics 04/27/2011Hafsabibi D
MolenoEPSDT Supplemental ServicesProvider Dietetics 03/08/2006Maria C
Page 247 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Moncrief Speech Therapist Speech Language Pathology 02/25/2010Amber
MonkEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 03/10/2011Nicole A
MonroeEPSDT Supplemental ServicesProvider Dietetics 09/08/2011Raquel B
MontecilloEPSDT Supplemental ServicesProvider Dietetics 08/10/2011Dawn D
MontellanoEPSDT Supplemental ServicesProvider Dietetics 08/15/2007Jennifer C
MontezEPSDT Supplemental ServicesProvider Social Work 09/24/2009Rebecca
Montgomery Audiologist Audiology 01/05/2010Shandra
MontillanoEPSDT Supplemental ServicesProvider Dietetics 05/13/2009Sherill H
Page 248 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MontoyaEPSDT Supplemental ServicesProvider Social Work 02/28/2011Yolanda E
Monty Occupational Therapist Occupational Therapy 06/09/2011Brian D
Moody Physician Pediatrics 04/21/2010Dawnell J
Mooney-Conkle Speech Therapist Speech Language Pathology 10/30/2009Martha K
Moore Audiologist Audiology 03/03/2008Charlotte M
MooreEPSDT Supplemental ServicesProvider Social Work 07/26/2007Jennifer L
Moore Speech Therapist Speech Language Pathology 05/18/2012Lisa M
Moore Psychologist Psychology 01/29/2009Mary E
Page 249 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Moore Speech Therapist Speech Language Pathology 02/09/2010Rachelle K
MoradiansEPSDT Supplemental ServicesProvider Social Work 06/17/2008Tanya J
MoralesEPSDT Supplemental ServicesProvider Dietetics 10/06/2011Melissa
MoralesEPSDT Supplemental ServicesProvider Social Work 03/01/1999Sally A
MoranEPSDT Supplemental ServicesProvider Social Work 03/08/2004Janet K
Moran Physical Therapist Physical Therapy 06/14/2006Shonna M
MorassoEPSDT Supplemental ServicesProvider Social Work 07/26/2010Elizabeth G
Morcos Physical Therapist Physical Therapy 04/07/2010Sally M
Page 250 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MorejonEPSDT Supplemental ServicesProvider Social Work 01/20/2011Alina
MorellEPSDT Supplemental ServicesProvider Social Work 01/18/2012Lillian J
MorenoEPSDT Supplemental ServicesProvider Social Work 09/14/2006Patricia E
Morgan Speech Therapist Speech Language Pathology 09/26/2006Alexandra H
MorganEPSDT Supplemental ServicesProvider Social Work 01/22/2009Helene D
Morgan Speech Therapist Speech Language Pathology 04/07/2003Maria
Morgan PhysicianPsychiatry and Neurology:Psychiatry 08/21/2006Sarah
Morgan-Lodin Physical Therapist Physical Therapy 11/01/1989Linda
Page 251 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Moriarty Speech Therapist Speech Language Pathology 07/21/2009Briana L
MoriwakiEPSDT Supplemental ServicesProvider Dietetics 06/30/2011Kimberlie D
Moro Occupational Therapist Occupational Therapy 08/22/2006Sandra C
Moroney Audiologist Audiology 03/23/2000Donna
Morris Occupational Therapist Occupational Therapy 07/15/2008Evan H
Morris Occupational Therapist Occupational Therapy 09/16/2002Yvonne D
Morris-Kelley Audiologist Audiology 10/27/2010Cassandra
MorrissetteEPSDT Supplemental ServicesProvider Social Work 05/08/2007Monika T
Page 252 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MorseEPSDT Supplemental ServicesProvider Social Work 07/21/2011Kimberly R
Mortensen Audiologist Audiology 08/23/2012Bryan
Moschella Physician Family Medicine 01/06/2006Joann E
Moseley Physician Orthopaedic Surgery 03/01/1987Colin F
Moss Audiologist Audiology 11/01/2000Rachel M
Mostofi Physician Family Medicine 10/05/2006Afsheen
Motadel Physician Pediatrics 06/10/2008Kelly C
Motz Audiologist Audiology 03/12/2007Debra A
Page 253 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Mouboiadjian Speech Therapist Speech Language Pathology 08/26/2009Zarui
MoyEPSDT Supplemental ServicesProvider Social Work 02/01/1993Natalie W
Moyer Audiologist Audiology 10/06/2008Catherine J
MozingoEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/09/2010Jennifer R
Mugford Speech Therapist Speech Language Pathology 04/19/2012Elizabeth A
MuirEPSDT Supplemental ServicesProvider Social Work 01/20/2011Jamie M
Mullenax Physician Pediatrics 12/12/2011Jean
Mullick Physician Pediatrics 02/21/2001Alpna
Page 254 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MulugetaEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/15/2012Netsanet
MulvihillEPSDT Supplemental ServicesProvider Dietetics 05/15/2006Lorraine C
Mundell-Noel Audiologist Audiology 12/16/2011Ann M
MungerEPSDT Supplemental ServicesProvider Social Work 12/12/2007Sheila D
MunozEPSDT Supplemental ServicesProvider Social Work 06/01/1997Maria C
Munsey Physical Therapist Physical Therapy 05/01/1997Kristin E
Murakami Audiologist Audiology 01/06/2010Setsuko L
MurataEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 12/07/2010Kristina
Page 255 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MurdicaEPSDT Supplemental ServicesProvider Social Work 03/16/2009amy
Murin Physical Therapist Physical Therapy 09/12/2007Courtney
Murphy Physician Pediatrics 10/10/2012Carmel
MurphyEPSDT Supplemental ServicesProvider Social Work 06/01/2011Jo Anne
Murphy Speech Therapist Speech Language Pathology 01/22/2009Mary Ellen
MurphyEPSDT Supplemental ServicesProvider Social Work 11/03/2008Norina
MurphyEPSDT Supplemental ServicesProvider Social Work 05/31/2006Wendy H
Murphy Stanton Occupational Therapist Occupational Therapy 03/27/2009Maureen E
Page 256 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
MurrayEPSDT Supplemental ServicesProvider Social Work 05/12/2005Jennifer J
MurrayEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/23/2005Michelle L
MuseEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/06/2011Kerry A
Musick Physical Therapist Physical Therapy 06/01/1991Tracey L
MuskatEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 12/01/2004Mica
MusterEPSDT Supplemental ServicesProvider Social Work 01/09/2012Kirsten L
Mycroft Physical Therapist Physical Therapy 08/28/2009Fred A
Naccarato Occupational Therapist Occupational Therapy 05/25/2010Chrystalyn C
Page 257 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Nadenichek Physical Therapist Physical Therapy 12/19/2005Nancy G
Nagel Psychologist Psychology 08/03/2005PhD
NakamuraEPSDT Supplemental ServicesProvider Dietetics 05/28/2008Mayumi A
NamEPSDT Supplemental ServicesProvider Social Work 07/23/2008Karen M
Namsang Speech Therapist Speech Language Pathology 05/11/2012Abigail
Napier-Ionascu Psychologist Psychology 12/07/2010Nicolle R
Naquila Occupational Therapist Occupational Therapy 08/29/2011Marxia A
Narvarte Audiologist Audiology 10/20/2005Valerie B
Page 258 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
NaskletiEPSDT Supplemental ServicesProvider Social Work 08/08/2006Maria J
Nath Physician Family Medicine 07/22/2011Devarshi
Nathan Audiologist Audiology 03/05/2009Dianna L
NavarroEPSDT Supplemental ServicesProvider Social Work 09/10/2007Paulette P
Navarro-MontejanoEPSDT Supplemental ServicesProvider Social Work 03/25/2008Rosalinda M
NaylorEPSDT Supplemental ServicesProvider Social Work 02/04/2011Rachel G
Neal Speech Therapist Speech Language Pathology 05/31/2011Carrie B
NealyEPSDT Supplemental ServicesProvider Social Work 06/15/2010Yvette R
Page 259 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Nedved Physician Obstetrics and Gynecology 04/27/2007Lonnie J
Needleman Audiologist Audiology 05/28/2008Alyssa R
Negrini Occupational Therapist Occupational Therapy 08/06/2012Regina H
Neikirk Psychologist Psychology 04/05/2010Gina L
Neimy Occupational Therapist Occupational Therapy 04/09/2003Mary E
Nelson Speech Therapist Speech Language Pathology 02/22/2012Amber E
Nelson Psychologist Psychology 06/01/2010Denise R
Nelson Occupational Therapist Occupational Therapy 02/21/2002Jocelyn
Page 260 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Nelson Occupational Therapist Occupational Therapy 11/08/1983Judith
Nelson Physician Internal Medicine 04/16/2012 04/15/2015Nicholas
Neuendorff Occupational Therapist Occupational Therapy 08/21/2007Cynthia A
Neufeld Psychologist Psychology 08/20/2001Jonathan D
neveauEPSDT Supplemental ServicesProvider Social Work 07/03/2012monica
Neves Physician Pediatrics 08/02/2011Vanessa
Neville Occupational Therapist Occupational Therapy 09/15/2003Patricia A
NewbergEPSDT Supplemental ServicesProvider Social Work 12/20/2006Denise M
Page 261 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
NewberryEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/16/2012Shelly L
Newell Physician Pediatrics 04/05/2011Chad
Newman Occupational Therapist Occupational Therapy 02/10/2009Carolyn A
Newman Speech Therapist Speech Language Pathology 07/01/1986Doreen M
Newmark Physical Therapist Physical Therapy 10/28/2008Amy C
NewsumEPSDT Supplemental ServicesProvider Social Work 11/07/2006Linda A
NewtonEPSDT Supplemental ServicesProvider Social Work 10/09/2008Diane
Ng Occupational Therapist Occupational Therapy 01/20/2012Pauline W
Page 262 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Ng Physician Pediatrics 05/01/1998Peter
Ng Physical Therapist Physical Therapy 11/01/1993Ruby
Ng Physician Pediatrics 02/17/2011Theresa M
Ngai Physical Therapist Physical Therapy 03/09/2012Ngayin
Ngau Occupational Therapist Occupational Therapy 01/08/2004Susan M
Ngo Physical Therapist Physical Therapy 05/19/2009Andrew B
NgoEPSDT Supplemental ServicesProvider Social Work 02/20/2004Christina T
Nguyen Physician Pediatrics 04/11/2012 04/10/2015Anna O
Page 263 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
NguyenEPSDT Supplemental ServicesProvider Dietetics 01/09/2006Huong L
NguyenEPSDT Supplemental ServicesProvider Dietetics 05/24/2005Krystine T
Nguyen Occupational Therapist Occupational Therapy 03/10/2009Loan
NguyenEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/30/2012Vy
NichollEPSDT Supplemental ServicesProvider Dietetics 01/15/2010Jana D
NichollsEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/24/2010Diane
Nichols Physician Allergy and Immunology 10/22/2007Breck R
Nichols Physician Internal Medicine 10/12/2007Breck R
Page 264 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Nichols Physician Pediatrics 10/12/2007Breck R
NicholsEPSDT Supplemental ServicesProvider Social Work 01/08/2008Lisa M
Nicholson Audiologist Audiology 01/25/2011Denise D
Nicholson Physician Family Medicine 09/11/2006Richard E
Niederreiter Physical Therapist Physical Therapy 09/22/2009Mary M
Nielsen Physical Therapist Physical Therapy 01/01/1993Sylvia F
NilforoushEPSDT Supplemental ServicesProvider Dietetics 10/29/2012Argavan
Nillasca Physical Therapist Physical Therapy 02/24/2012Jacqueline M
Page 265 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Nino Occupational Therapist Occupational Therapy 01/09/2012Denver E
NisenbaumEPSDT Supplemental ServicesProvider Social Work 09/20/2012Heather
NishiuraEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/03/2011Lindy F
NjokuEPSDT Supplemental ServicesProvider Social Work 10/24/2008Raphael C
Noble Occupational Therapist Occupational Therapy 10/01/2002Cassandra S
Nokes Audiologist Audiology 07/01/2001Erin F
Nolan Audiologist Audiology 05/31/2002Steven C
NordstrandEPSDT Supplemental ServicesProvider Social Work 11/07/2011Jennifer M
Page 266 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
NoriegaEPSDT Supplemental ServicesProvider Social Work 02/01/2007Debbie L
Norman-JohnsonEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/07/2008Staci M
NorrisEPSDT Supplemental ServicesProvider Dietetics 01/08/2008Stacey G
Norton Physical Therapist Physical Therapy 08/26/2009Charlotte O
Norton Physical Therapist Physical Therapy 09/29/2005Ellen S
Norvell Physician Family Medicine 05/20/2008Cindy J
NovaEPSDT Supplemental ServicesProvider Social Work 03/13/2009Zoila D
NovakEPSDT Supplemental ServicesProvider Dietetics 11/10/2009Patricia L
Page 267 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Novak Occupational Therapist Occupational Therapy 02/10/2012Sara M
NovalEPSDT Supplemental ServicesProvider Dietetics 12/04/2007Jerl Jean
Novalis-Heshejin Speech Therapist Speech Language Pathology 06/06/2012Lisa Dawn
Nowak-PrzygodzkiEPSDT Supplemental ServicesProvider Dietetics 07/27/2007Jill M
Nozuki Speech Therapist Speech Language Pathology 08/14/2007Asami
NunezEPSDT Supplemental ServicesProvider Social Work 01/17/2012Roselyn E
Nunez-BonomoEPSDT Supplemental ServicesProvider Social Work 05/01/1994Yolanda
Nunnink Psychologist Psychology 12/23/2008Sarah E
Page 268 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
NwaforEPSDT Supplemental ServicesProvider Social Work 09/05/2007Chioma U
Nye Occupational Therapist Occupational Therapy 02/19/2008Jennifer L
NzeremEPSDT Supplemental ServicesProvider Dietetics 02/01/2012Nkiru C
OaksEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 06/19/2007Angela
O'BRIENEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/22/2011Colette R
O'BrienEPSDT Supplemental ServicesProvider Dietetics 12/01/1994Patricia L
O'Brien Physical Therapist Physical Therapy 10/11/2012Shannon F
Ocampo Speech Therapist Speech Language Pathology 05/13/2010Alaine S
Page 269 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Odle Speech Therapist Speech Language Pathology 09/17/2009Jill
OjogEPSDT Supplemental ServicesProvider Dietetics 06/30/2009Manuela
Okazaki Physical Therapist Physical Therapy 03/01/2001Susan D
O'KeeffeEPSDT Supplemental ServicesProvider Social Work 02/15/2008Mary Grace
Oku Physical Therapist Physical Therapy 03/16/2009Ann H
OkwachEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/22/2011Clarise A
OladunjoyeEPSDT Supplemental ServicesProvider Dietetics 08/29/2011Ayodeji A
OliverEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/01/2010Michele C
Page 270 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
OLIVERAEPSDT Supplemental ServicesProvider Social Work 03/31/2008SONIA
Olsen Occupational Therapist Occupational Therapy 04/19/2005Nancy E
Olson Occupational Therapist Occupational Therapy 07/21/2011Brooke M
OlsonEPSDT Supplemental ServicesProvider Dietetics 12/22/2009Caryn A
OlsonEPSDT Supplemental ServicesProvider Social Work 01/29/2008Dawn M
OlsonEPSDT Supplemental ServicesProvider Social Work 07/17/2007Karin G
O'NealEPSDT Supplemental ServicesProvider Social Work 08/08/2011Lisette T
O'Neill Physical Therapist Physical Therapy 09/09/2011Lauren J
Page 271 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
O'Neill-LopezEPSDT Supplemental ServicesProvider Social Work 07/03/2007Leilani C
Ong Physical Therapist Physical Therapy 03/16/2006Anna Marie Y
Opsvig Physical Therapist Physical Therapy 05/05/2008Todd A
OrellanaEPSDT Supplemental ServicesProvider Social Work 03/16/2010Ana
OrelliEPSDT Supplemental ServicesProvider Social Work 12/03/2007Theresa C
Orloff Physician Family Medicine 03/07/2006Feoktist N
OroscoEPSDT Supplemental ServicesProvider Social Work 04/21/2009Guadalupe
OrtanezEPSDT Supplemental ServicesProvider Social Work 06/15/2011Camille
Page 272 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Ortiz Physician Internal Medicine 05/01/2005Joseph D
OrtizEPSDT Supplemental ServicesProvider Social Work 01/26/2012Renee M
Ortiz Singh Physician Family Medicine 10/30/2007Janice C
Ortlieb Speech Therapist Speech Language Pathology 09/14/2012Kelly Rowan
OrzechEPSDT Supplemental ServicesProvider Dietetics 08/28/2006Shoshanah
Osborne Speech Therapist Speech Language Pathology 06/01/2007Stephanie A
OsderEPSDT Supplemental ServicesProvider Social Work 12/06/2005Stacey L
Oseguera Physician Family Medicine 09/29/2009Maria D
Page 273 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
OsherEPSDT Supplemental ServicesProvider Social Work 02/07/2011Constance M
Osterloh Physical Therapist Physical Therapy 05/22/2006Katherine G
Ostrea Physician Pediatrics 07/06/2011Marilou O
OusleyEPSDT Supplemental ServicesProvider Social Work 12/23/2008Karina M
Outlaw-Edwards Occupational Therapist Occupational Therapy 05/19/2009Araceli O
Outzen Occupational Therapist Occupational Therapy 01/06/2009Marianne
OverleyEPSDT Supplemental ServicesProvider Social Work 01/09/2012Jennifer A
Owen Occupational Therapist Occupational Therapy 07/12/2011Christine L
Page 274 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
PabloEPSDT Supplemental ServicesProvider Dietetics 01/05/2009Patrick C
PaceEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/09/2012Rojauna Kwan
Paek Physician Pediatrics 08/06/2009Sung H
PaezEPSDT Supplemental ServicesProvider Social Work 06/12/2012Michelle
Pair Physical Therapist Physical Therapy 02/01/1987Robert D
Pak Speech Therapist Speech Language Pathology 12/06/2006Caroline J
Palermo Audiologist Audiology 10/15/2009Jannette L
Palm Psychologist Psychology 06/18/2009Jacob A
Page 275 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Palma Fiallos Physician Family Medicine 11/04/2009Elsy N
Palmer Physician Surgery: (general) 08/09/2012Barnard J
PalmerEPSDT Supplemental ServicesProvider Social Work 01/13/2012Jennifer E
Palmer Physical Therapist Physical Therapy 07/31/2007Maynell
PalmerEPSDT Supplemental ServicesProvider Social Work 04/04/2008Sarah M
Palomero Physician Family Medicine 12/29/2008Grewen
Paltin Physician Family Medicine 05/20/2008Sharon R
Pan Physician Pediatrics 02/19/2000Sofia W
Page 276 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Panaro Physical Therapist Physical Therapy 04/06/2009Krista M
PangEPSDT Supplemental ServicesProvider Dietetics 07/22/2008Judy M
PanicoEPSDT Supplemental ServicesProvider Dietetics 02/15/2006Linda C
PappasEPSDT Supplemental ServicesProvider Social Work 08/03/2006Juliet A
Pappas PhysicianPsychiatry and Neurology:Psychiatry 03/07/2006Lynne
PaquetteEPSDT Supplemental ServicesProvider Social Work 12/20/2006Holly M
Paquette Psychologist Psychology 11/02/2009Karleen R
Parekh Audiologist Audiology 12/04/2007Martine D
Page 277 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Parikh Physical Therapist Physical Therapy 09/03/2009Mansi
Park Physician Surgery: (general) 05/18/2012Chan
Park Physician Pediatrics 01/20/2004Christine L
ParkEPSDT Supplemental ServicesProvider Social Work 01/17/2008Jennifer C
ParkEPSDT Supplemental ServicesProvider Social Work 02/04/2011Joan L
Park Physical Therapist Physical Therapy 05/08/2009Lea M
Park Physician Pediatrics 09/20/2002Maggie S
Park Speech Therapist Speech Language Pathology 12/27/2006Soyoung
Page 278 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Park Physician Pediatrics 02/20/2007Sue Ann
ParkerEPSDT Supplemental ServicesProvider Social Work 11/01/1998Brenda S
Parker Physical Therapist Physical Therapy 04/02/2004Karen S
ParkerEPSDT Supplemental ServicesProvider Social Work 04/05/2006Mildred E
ParkerEPSDT Supplemental ServicesProvider Social Work 03/27/2006Todd S
Parker Lopez Speech Therapist Speech Language Pathology 04/15/2000Jenifer A
Parker-SmeltzerEPSDT Supplemental ServicesProvider Social Work 12/19/2011Jacqueline T
Parkinson Occupational Therapist Occupational Therapy 08/22/2006Judy P
Page 279 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ParksEPSDT Supplemental ServicesProvider Social Work 12/11/2008Amy R
ParrettEPSDT Supplemental ServicesProvider Dietetics 02/01/2011Bethany L
Parrish Occupational Therapist Occupational Therapy 03/26/1997Nancy E
Parry Physical Therapist Physical Therapy 01/25/2012Ingrid S
Pascual Occupational Therapist Occupational Therapy 05/22/2009Marielle
Passerino Occupational Therapist Occupational Therapy 03/21/2008Thomas P
Pasterski Physical Therapist Physical Therapy 03/19/2002Robin
PateEPSDT Supplemental ServicesProvider Social Work 10/15/2008Sandra M
Page 280 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Patee Occupational Therapist Occupational Therapy 12/01/1998Stacey
Patel Physician Internal Medicine 09/04/2007Anupama
Patel Physician Pediatrics 09/04/2007Anupama
PatelEPSDT Supplemental ServicesProvider Dietetics 03/30/2010Jagna G
PatrickEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/26/2010Deborah L
Patrizi Physical Therapist Physical Therapy 06/01/1998Debra
PattersonEPSDT Supplemental ServicesProvider Social Work 01/12/2012Carmen N
PattersonEPSDT Supplemental ServicesProvider Social Work 06/08/2009Katerina S
Page 281 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Patterson Physical Therapist Physical Therapy 06/24/2009William J
PattonEPSDT Supplemental ServicesProvider Social Work 08/01/1994Angela M
Paul Psychologist Psychology 12/15/2009Brianna M
PaulEPSDT Supplemental ServicesProvider Social Work 10/22/2007Robin A
PayneEPSDT Supplemental ServicesProvider Social Work 07/21/2004Jennifer
PayneEPSDT Supplemental ServicesProvider Social Work 07/21/2004Jennifer S
PayneEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/02/2012Laura P
Peacock Occupational Therapist Occupational Therapy 03/18/2009Leticia A
Page 282 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
PearceEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/05/2009Christina E
Peck-Murray Occupational Therapist Occupational Therapy 11/01/1994Jill
PedersenEPSDT Supplemental ServicesProvider Social Work 11/14/2012Kylie
PederzoliEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/07/2003Paola Iliana
PedroEPSDT Supplemental ServicesProvider Social Work 12/24/2010Dorothy
PeekeEPSDT Supplemental ServicesProvider Social Work 04/11/2011Nicole J
PellizzariEPSDT Supplemental ServicesProvider Social Work 02/01/2007Clara J
PenaEPSDT Supplemental ServicesProvider Social Work 03/23/2007Christina M
Page 283 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Pena Physician Pediatrics 08/17/1971Ivette C
Pendleton Speech Therapist Speech Language Pathology 01/25/2008Julie N
Peneueta Speech Therapist Speech Language Pathology 11/19/2009Ramey A
PengEPSDT Supplemental ServicesProvider Dietetics 12/15/2009Carol S
PenidoEPSDT Supplemental ServicesProvider Social Work 02/04/2011Marcia L
Penoliar Occupational Therapist Occupational Therapy 11/16/2009Lauren N
Penrose Physician Ophthalmology 08/30/2012Philip
PerezEPSDT Supplemental ServicesProvider Social Work 04/23/2010Erika P
Page 284 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
PerezEPSDT Supplemental ServicesProvider Social Work 06/05/2008Francisco J
Perez Physical Therapist Physical Therapy 01/23/2006Julie K
PerezEPSDT Supplemental ServicesProvider Social Work 09/01/1999Michael
Peris Psychologist Psychology 08/23/2010Tara S
PeritoreEPSDT Supplemental ServicesProvider Dietetics 03/05/2012Marianne
PerkinsEPSDT Supplemental ServicesProvider Social Work 11/05/2009Timothy
Perryman Physical Therapist Physical Therapy 09/12/2007Leesha S
PersakEPSDT Supplemental ServicesProvider Dietetics 08/31/2011Eve M
Page 285 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Persson Physical Therapist Physical Therapy 11/06/2007Lena Inger K
Pesce Physical Therapist Physical Therapy 09/19/2011Sarah E
Peter Audiologist Audiology 12/06/2007Judith H
PetersEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/21/2011Katherine R
Peters Speech Therapist Speech Language Pathology 06/12/2008Tara J
Peterson Physician Internal Medicine 07/20/2007Erica
Peterson Physician Pediatrics 07/20/2007Erica
Peterson Occupational Therapist Occupational Therapy 09/01/2009Nicole R
Page 286 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
PetersonEPSDT Supplemental ServicesProvider Dietetics 02/22/2010Vanessa M
PetrossianEPSDT Supplemental ServicesProvider Dietetics 05/01/1995Tammy L
PettitEPSDT Supplemental ServicesProvider Social Work 02/01/2000Peggy D
PhamEPSDT Supplemental ServicesProvider Social Work 12/09/2005Ngoc
Pham Bui Occupational Therapist Occupational Therapy 04/08/2008Trang T
Philliposian Audiologist Audiology 02/28/2003Carey
PhillipsEPSDT Supplemental ServicesProvider Social Work 04/13/2012Jenelle L
PhillipsEPSDT Supplemental ServicesProvider Dietetics 04/23/2009Wendy L
Page 287 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
PhilpotEPSDT Supplemental ServicesProvider Social Work 07/01/2003Margarita
PiatkowskiEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/29/2012Brian A
Piazza Psychologist Psychology 06/27/2006Fred J
PieperEPSDT Supplemental ServicesProvider Social Work 01/27/2012Sheri A
PierceEPSDT Supplemental ServicesProvider Social Work 02/12/2000Eric A
PieriEPSDT Supplemental ServicesProvider Social Work 02/17/2006Joy M
PikeEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/30/2010Nancy A
PilramEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/24/2006Alice J
Page 288 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Pina Physical Therapist Physical Therapy 10/21/2002Bettye R
Pine Physical Therapist Physical Therapy 03/07/2005Elizabeth
Pineda Physical Therapist Physical Therapy 03/09/2012Isabel B
Pintus Physical Therapist Physical Therapy 03/16/2006Kerstin A
Pitsch Physical Therapist Physical Therapy 12/16/2011Erica
PittaEPSDT Supplemental ServicesProvider Dietetics 08/07/2000Dalila
Pitts Physical Therapist Physical Therapy 05/17/2011Melissa R
Pivonka-Jones Psychologist Psychology 09/08/2011Jamie
Page 289 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Ploszaj Occupational Therapist Occupational Therapy 08/22/2011Ann M
PlushEPSDT Supplemental ServicesProvider Social Work 04/13/2012Rochelle
Poblete Physical Therapist Physical Therapy 08/15/2008Mary E
PohlEPSDT Supplemental ServicesProvider Social Work 02/08/2008Lori K
PohlEPSDT Supplemental ServicesProvider Social Work 03/23/2004Olivia E
Polard Physical Therapist Physical Therapy 07/21/2009Kimnesha S
Pollock Psychologist Psychology 05/02/2007Adam E
Polo-JacobssonEPSDT Supplemental ServicesProvider Social Work 04/21/2008Estela M
Page 290 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
PomerantzEPSDT Supplemental ServicesProvider Social Work 05/01/1998Gila
poolerEPSDT Supplemental ServicesProvider Social Work 07/06/2012laura
Popelka Audiologist Audiology 01/16/2009Gerald R
Popovich Speech Therapist Speech Language Pathology 08/10/2010Kristin L
PoquizEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/03/2011May Z
Porter Occupational Therapist Occupational Therapy 05/07/2007Cathy L
Porter Occupational Therapist Occupational Therapy 08/28/2003Eileen H
PorterfieldEPSDT Supplemental ServicesProvider Dietetics 10/10/2006Tiffanie C
Page 291 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
portjeEPSDT Supplemental ServicesProvider Social Work 07/03/2012cathy
Portje-richardsonEPSDT Supplemental ServicesProvider Social Work 03/01/1993Cathleen S
Potok Prosthetist Prosthetics/Orthotics 05/06/2011Bryan S
Potts Speech Therapist Speech Language Pathology 04/10/2009Cameron
PourianEPSDT Supplemental ServicesProvider Dietetics 04/16/2012Noushin
PowellEPSDT Supplemental ServicesProvider Social Work 07/03/2007Alba L
PowellEPSDT Supplemental ServicesProvider Social Work 12/07/2003Desarne
PowellEPSDT Supplemental ServicesProvider Dietetics 11/29/2005Shirley
Page 292 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Power Physical Therapist Physical Therapy 09/14/2009Patricia N
PraggastisEPSDT Supplemental ServicesProvider Social Work 07/28/2003Ilda M
Prasad-AguileraEPSDT Supplemental ServicesProvider Social Work 08/03/2011Anita M
PrattEPSDT Supplemental ServicesProvider Social Work 06/01/1993Wanda
Prehn DespotaEPSDT Supplemental ServicesProvider Social Work 11/16/2012Cara N
Premysler Physical Therapist Physical Therapy 11/09/2010Cathy R
PrenticeEPSDT Supplemental ServicesProvider Social Work 12/03/2007Samuel E
Prescher Physical Therapist Physical Therapy 12/26/2008Kelly L
Page 293 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
PresleyEPSDT Supplemental ServicesProvider Social Work 03/03/2008Rodney D
PressEPSDT Supplemental ServicesProvider Social Work 05/01/2007Carole E
PriceEPSDT Supplemental ServicesProvider Social Work 06/16/2011Renee M
Prior Physical Therapist Physical Therapy 04/05/2010Marguerite A
Privratsky Physical Therapist Physical Therapy 03/04/2008August B
Puccinelli Occupational Therapist Occupational Therapy 09/11/2006Karin A
Puchovitz Occupational Therapist Occupational Therapy 01/12/2009Sarah M
Puertas Physician Family Medicine 04/05/2006Ricardo
Page 294 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Puranam Physician Internal Medicine 09/28/2012Srilekha
Purdy Audiologist Audiology 06/05/2006Julie K
PutnamEPSDT Supplemental ServicesProvider Social Work 08/29/2011Geniella C
PwuEPSDT Supplemental ServicesProvider Dietetics 05/25/2007Yu-Chu
Qamar Physician Family Medicine 04/01/2008Samina
Qualman Speech Therapist Speech Language Pathology 11/25/2002Haven E
Quam Physician Pediatrics 11/12/2008Yolanda Y
QuanEPSDT Supplemental ServicesProvider Social Work 12/29/2006Joanna L
Page 295 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Quan Occupational Therapist Occupational Therapy 07/27/2007Lynn S
Quezada Physical Therapist Physical Therapy 03/14/2000Kristin N
QuezadaEPSDT Supplemental ServicesProvider Social Work 03/27/2009Leticia
Quillian Physician Pediatrics 08/22/2011Alan E
QuinnEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/01/2010Juliana
Quintana Occupational Therapist Occupational Therapy 10/29/1979Loreto M
Quintero Speech Therapist Speech Language Pathology 08/29/2005Ann K
Quiroz-MunozEPSDT Supplemental ServicesProvider Social Work 04/07/2004Alma D
Page 296 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Quraishy Physical Therapist Physical Therapy 09/15/2006Karyn
RabelEPSDT Supplemental ServicesProvider Social Work 05/24/2005Janice M
Raczko Occupational Therapist Occupational Therapy 04/03/2007Cynthia S
Radice Speech Therapist Speech Language Pathology 09/20/2011Elisa L
Radovich Physical Therapist Physical Therapy 10/16/2007Martha
Ragland Psychologist Psychology 06/03/2008John D
Rahimi Physician Pediatrics 03/15/2010Nassrin
RahimianEPSDT Supplemental ServicesProvider Social Work 08/12/2010Pantea
Page 297 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Raiden-WrightEPSDT Supplemental ServicesProvider Social Work 11/01/1998Linda H
Raiden-WrightEPSDT Supplemental ServicesProvider Social Work 11/01/1998Linda 'Hannah' H
Raj Physician Family Medicine 04/06/2009Satish P
Rakoski Occupational Therapist Occupational Therapy 04/13/2006Douglas R
Ralston Occupational Therapist Occupational Therapy 11/30/2006Elizabeth B
Ramirez Speech Therapist Speech Language Pathology 07/02/2008Alicia
RamirezEPSDT Supplemental ServicesProvider Social Work 10/21/2008Caroline S
RamirezEPSDT Supplemental ServicesProvider Social Work 01/22/2007Elda A
Page 298 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Ramirez Physical Therapist Physical Therapy 03/10/2011Fasia R
RamirezEPSDT Supplemental ServicesProvider Social Work 05/07/2008Maria C
Ramirez Speech Therapist Speech Language Pathology 06/18/2009Michelle J
RamirezEPSDT Supplemental ServicesProvider Social Work 10/16/2008Patricia
RamirezEPSDT Supplemental ServicesProvider Social Work 11/10/2010Sylvia R
Ramirez-CampuzanoEPSDT Supplemental ServicesProvider Social Work 06/05/2007Judy
RamosEPSDT Supplemental ServicesProvider Dietetics 06/26/2009Candice C
RamosEPSDT Supplemental ServicesProvider Social Work 02/01/2007Jose
Page 299 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Ramos Physician Allergy and Immunology 07/03/2008Madeleine S
Ramos Physician Internal Medicine 07/03/2008Madeleine S
RamosEPSDT Supplemental ServicesProvider Social Work 08/25/2010Monica L
Ramsey Audiologist Audiology 11/05/2007Robin M
Rana Physician Pediatrics 09/16/2008Deborah T
RandEPSDT Supplemental ServicesProvider Dietetics 06/07/2004Jill M
Rand Physical Therapist Physical Therapy 09/01/1996Susan D
RandelEPSDT Supplemental ServicesProvider Dietetics 12/13/2005Monica
Page 300 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RanganEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 12/15/2003Kasey
RangelEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 06/25/2012Dolores
RangelEPSDT Supplemental ServicesProvider Social Work 02/01/2007Heather N
RansburyEPSDT Supplemental ServicesProvider Dietetics 01/25/2006Kirsten R
Rao Physician Pediatrics: Pediatric Cardiology 03/22/2007Srinadh O
Rappaport Occupational Therapist Occupational Therapy 04/07/2010Kary B
RasmussenEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/01/2012Susan Michele
RatcliffEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 03/20/2012Rebecca
Page 301 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RathEPSDT Supplemental ServicesProvider Social Work 08/30/2010Stacy L
Rauda Guardado Occupational Therapist Occupational Therapy 08/22/2006Hisela B
Ray Psychologist Psychology 05/10/2010Lara A
RealEPSDT Supplemental ServicesProvider Social Work 05/24/2006Frances
Reardon-PuentesEPSDT Supplemental ServicesProvider Dietetics 08/20/2003Stella Y
Recht Physician Family Medicine 04/28/2010Brian R
RechtegerEPSDT Supplemental ServicesProvider Social Work 08/08/2006Heidi
Reddy Physician Family Medicine 02/07/2006Aruna S
Page 302 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Reece Speech Therapist Speech Language Pathology 04/25/2012Benjamin K
Reed Audiologist Audiology 10/19/2012Analisa
Reed Physical Therapist Physical Therapy 12/12/2006Dana C
ReedEPSDT Supplemental ServicesProvider Social Work 10/21/2008Laura S
Reeder Speech Therapist Speech Language Pathology 08/14/2008Jennifer A
RegerEPSDT Supplemental ServicesProvider Social Work 12/12/2007Pamela G
ReichelsdorfEPSDT Supplemental ServicesProvider Dietetics 02/06/2006Charlotte M
Reid Physician Pediatrics 01/01/2003Joanne E
Page 303 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Reineke Psychologist Psychology 09/19/2011Anke
Reinhold Speech Therapist Speech Language Pathology 03/08/2010Kristina L
Reisert Occupational Therapist Occupational Therapy 09/26/2007Maria M
ReissEPSDT Supplemental ServicesProvider Social Work 08/06/2003Marci E
Reposo Physical Therapist Physical Therapy 11/03/2009Judith M
Resedea PhysicianPsychiatry and Neurology:Psychiatry 06/07/2012Cynthia I
ResendezEPSDT Supplemental ServicesProvider Social Work 08/22/2006Maribel
ResselEPSDT Supplemental ServicesProvider Dietetics 12/15/2008Monika K
Page 304 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ReuschEPSDT Supplemental ServicesProvider Social Work 03/13/2007Rebecca L
ReutherEPSDT Supplemental ServicesProvider Social Work 06/20/2011Krista
RevardEPSDT Supplemental ServicesProvider Social Work 08/29/2006Ann
Revilla Physician Pediatrics 04/21/2010Ana R
ReyesEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/30/2005Ma Luz
Reyes Physical Therapist Physical Therapy 05/19/2004Pilar C
ReyesEPSDT Supplemental ServicesProvider Social Work 11/01/2011Roxanne
ReyesEPSDT Supplemental ServicesProvider Social Work 03/16/2007Sally A
Page 305 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Reyes-OsorioEPSDT Supplemental ServicesProvider Social Work 01/21/2004Osmara
ReynoldsEPSDT Supplemental ServicesProvider Social Work 12/30/2008Ashley R
Reynolds Occupational Therapist Occupational Therapy 04/03/2008Carly A
ReynoldsEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 12/20/2005Marie E
ReynosoEPSDT Supplemental ServicesProvider Social Work 03/28/2006Bettina C
ReynosoEPSDT Supplemental ServicesProvider Social Work 04/11/2006Esmeralda
RhyneEPSDT Supplemental ServicesProvider Social Work 01/20/2011Cynthia S
Ricardo-Ortiz Physician Pediatrics 04/01/1980Marylin
Page 306 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RicchiutoEPSDT Supplemental ServicesProvider Dietetics 10/05/2011Abbey A
Rice Occupational Therapist Occupational Therapy 12/15/2011Emily P
RiceEPSDT Supplemental ServicesProvider Social Work 05/21/2007Melissa A
Rich Physical Therapist Physical Therapy 09/12/2008Roger H
RichardEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/02/2012Elizabeth Ann
RichardsEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/01/2012Mary T
Richards Audiologist Audiology 02/02/2007Rebecca E
RichardsonEPSDT Supplemental ServicesProvider Social Work 09/23/2011Kimberly A
Page 307 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Richey Occupational Therapist Occupational Therapy 05/19/2009Monica R
RichmondEPSDT Supplemental ServicesProvider Social Work 01/30/2008Barbara
RiddellEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/03/2011Stella F
Riddle Psychologist Psychology 11/01/1994Joseph M
Riddleberger Occupational Therapist Occupational Therapy 05/19/2010Julie C
RidgeEPSDT Supplemental ServicesProvider Social Work 12/23/2011Melissa A
RiemerEPSDT Supplemental ServicesProvider Social Work 09/24/2007Theresa A
RiessEPSDT Supplemental ServicesProvider Social Work 02/15/2007David A
Page 308 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RiganianEPSDT Supplemental ServicesProvider Social Work 04/17/2007Alice
Rikleen PhysicianPreventive Medicine: Public Healthand General 06/20/2012Daniel
RiosEPSDT Supplemental ServicesProvider Social Work 11/09/2009Charles
RiosEPSDT Supplemental ServicesProvider Dietetics 02/11/2011Norma A
RiosEPSDT Supplemental ServicesProvider Social Work 07/18/2006Theresa M
RippEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/21/2012Cheryl L
Ripple Physician Pediatrics 01/01/1998Richard W
Ritchey Physical Therapist Physical Therapy 07/01/1997Margaret J
Page 309 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Ritchie Physical Therapist Physical Therapy 11/19/2008Stacie A
Ritter Occupational Therapist Occupational Therapy 11/01/2000Cindy
Ritz Psychologist Psychology 02/14/2007Michael G
Rizzuto Occupational Therapist Occupational Therapy 10/25/2004Sandra
RoEPSDT Supplemental ServicesProvider Social Work 02/08/2007Susie
RoanEPSDT Supplemental ServicesProvider Dietetics 07/23/2010Marian E
RobberechtEPSDT Supplemental ServicesProvider Social Work 05/01/1995Donna A
Robbins Occupational Therapist Occupational Therapy 01/22/2008Julie E
Page 310 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RobertsEPSDT Supplemental ServicesProvider Dietetics 09/22/2000Ann-Marie
Roberts Audiologist Audiology 09/13/2006Rebekah M
RobertsonEPSDT Supplemental ServicesProvider Dietetics 11/15/2012Crystal
RobertsonEPSDT Supplemental ServicesProvider Social Work 07/01/1992Donna M
Robinson Prosthetist Prosthetics 03/12/2008Allan M
Robinson Prosthetist Prosthetics/Orthotics 03/12/2008Allan M
Robinson Psychologist Psychology 10/24/2008Athena S
Robinson Occupational Therapist Occupational Therapy 05/11/2010Debra R
Page 311 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Robinson Speech Therapist Speech Language Pathology 09/03/2008Lisa M
Robinson-MillerEPSDT Supplemental ServicesProvider Social Work 07/19/2010Wendy M
RoblesEPSDT Supplemental ServicesProvider Social Work 03/23/2007Amanda N
Robles Speech Therapist Speech Language Pathology 02/25/2004Maricela
RoblesEPSDT Supplemental ServicesProvider Social Work 11/09/2010Marlene
Robles Occupational Therapist Occupational Therapy 09/22/2003Minna C
Robles-Love Psychologist Psychology 04/21/2009Yvonne
RocheEPSDT Supplemental ServicesProvider Social Work 04/25/2012Amanda M
Page 312 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Rochen Speech Therapist Speech Language Pathology 06/01/2010Dana I
RodgersEPSDT Supplemental ServicesProvider Dietetics 07/09/2004Jane
RodriguezEPSDT Supplemental ServicesProvider Social Work 07/06/2010Alexa
RodriguezEPSDT Supplemental ServicesProvider Social Work 07/21/2008Anabel
Rodriguez PhysicianInternal Medicine: MedicalOncology 08/25/2003Annette
RodriguezEPSDT Supplemental ServicesProvider Social Work 07/21/2011Claudia M
RodriguezEPSDT Supplemental ServicesProvider Social Work 03/03/2009Jennifer M
Rodriguez Psychologist Psychology 02/04/2010Katherine
Page 313 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RodriguezEPSDT Supplemental ServicesProvider Social Work 03/28/2011Katrina M
RodriguezEPSDT Supplemental ServicesProvider Dietetics 06/07/2011Luis A
RodriguezEPSDT Supplemental ServicesProvider Social Work 04/04/2011Luis
Rodriguez Occupational Therapist Occupational Therapy 02/22/2010Melissa L
Rodriguez Physical Therapist Physical Therapy 01/09/2012Sandra
Rodriguez Speech Therapist Speech Language Pathology 02/17/2012Susana V
RodriguezEPSDT Supplemental ServicesProvider Social Work 10/28/2008Velma
RodriguezEPSDT Supplemental ServicesProvider Social Work 04/24/2009Xochilt
Page 314 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Rodriguez-Ukes Speech Therapist Speech Language Pathology 01/12/2010Kathleen R
RoeserEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 01/19/2011Kailee
Roger Speech Therapist Speech Language Pathology 09/12/2008Wendy T
Rogers Physical Therapist Physical Therapy 10/01/2010Brynn R
Rogers Occupational Therapist Occupational Therapy 04/04/2011Leah M
RogersEPSDT Supplemental ServicesProvider Dietetics 09/12/2012Lily
Rohde Speech Therapist Speech Language Pathology 09/14/2012Erin Stephanie
Rohnert Physical Therapist Physical Therapy 12/04/2007Laura E
Page 315 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Rojas Magallon Occupational Therapist Occupational Therapy 05/19/2009Adriana
Roley Physical Therapist Physical Therapy 08/22/2005Michelle D
RolfeEPSDT Supplemental ServicesProvider Social Work 12/01/1995Vickie N
Romero Physical Therapist Physical Therapy 09/28/2006Carlos Y
Romero Physical Therapist Physical Therapy 05/08/2009Carmen L
RomeroEPSDT Supplemental ServicesProvider Social Work 09/01/1996Jeannine M
RomeroEPSDT Supplemental ServicesProvider Social Work 09/14/2010Lisa R
Romero Audiologist Audiology 06/08/2011Sandra P
Page 316 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Romero-ArriagaEPSDT Supplemental ServicesProvider Social Work 02/16/2011Ana B
Romias Occupational Therapist Occupational Therapy 02/01/2012Tiffany T
Romo-Miranda Speech Therapist Speech Language Pathology 12/22/2009Sara
Roque Physician Pediatrics 04/14/2011Nina J
RosaEPSDT Supplemental ServicesProvider Social Work 10/15/2008Myrysha D
Rosa-BienenfeldEPSDT Supplemental ServicesProvider Social Work 07/14/2008Claudia Joan
Rose Speech Therapist Speech Language Pathology 04/05/2011Heather C
RosemanEPSDT Supplemental ServicesProvider Social Work 06/29/2007Eric R
Page 317 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RosenbergEPSDT Supplemental ServicesProvider Social Work 04/15/2005Debra A
RosenstockEPSDT Supplemental ServicesProvider Dietetics 08/02/2011Natalie A
Rosenthal Occupational Therapist Occupational Therapy 10/05/2005Rebecca J
RosenthalEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/30/2005Yael
RosnerEPSDT Supplemental ServicesProvider Social Work 12/19/2006Lorrie M
RosoffEPSDT Supplemental ServicesProvider Dietetics 02/13/2008Jessie E
Rossman Physical Therapist Physical Therapy 05/19/2004Lauren M
Rostoker Occupational Therapist Occupational Therapy 11/01/1999Nicole S
Page 318 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RotblattEPSDT Supplemental ServicesProvider Social Work 08/15/2006Maureen D
Roth Occupational Therapist Occupational Therapy 06/04/2009Annmarie J
Roth Speech Therapist Speech Language Pathology 12/02/2005Christina T
Roth Audiologist Audiology 03/26/2009Elizabeth L
Roth Speech Therapist Speech Language Pathology 04/20/2010Jessica K
RothchildEPSDT Supplemental ServicesProvider Social Work 06/24/2008Laini M
Rothermel Audiologist Audiology 01/05/2010Amy K
Roth-WeissEPSDT Supplemental ServicesProvider Social Work 01/01/1995Susan S
Page 319 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RoudebushEPSDT Supplemental ServicesProvider Social Work 10/21/2008Kimberly R
RouseEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 12/15/2005Norene I
RoutEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 01/25/2012Julie M
Roux PhysicianPsychiatry and Neurology:Psychiatry 07/25/2012Joanne
Rowe Physical Therapist Physical Therapy 08/18/2011Eileen T
Rowe Speech Therapist Speech Language Pathology 05/26/2000Karen
Rowell Physical Therapist Physical Therapy 01/07/2003Christine E
Royster Audiologist Audiology 03/13/2000Linda
Page 320 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RubenEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/07/2011Elizabeth A
RubinEPSDT Supplemental ServicesProvider Social Work 01/14/2008Caryn L
RubioEPSDT Supplemental ServicesProvider Dietetics 01/19/2007Karen A
RuchteEPSDT Supplemental ServicesProvider Social Work 06/01/1999Margaret E
Rucker Physical Therapist Physical Therapy 12/06/2005Brenda J
Rugala PersiconeEPSDT Supplemental ServicesProvider Social Work 01/27/2010Jennifer N
RuizEPSDT Supplemental ServicesProvider Social Work 04/08/2008Amy E
RuizEPSDT Supplemental ServicesProvider Social Work 09/20/2010Denise M
Page 321 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RuizEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/29/2010Sinforosa
Ruiz-AlvaradoEPSDT Supplemental ServicesProvider Social Work 03/17/2006Cynthia E
Ruiz-VasquezEPSDT Supplemental ServicesProvider Social Work 11/08/1983Maria C
Russel Occupational Therapist Occupational Therapy 08/01/1999Elizabeth S
RussellEPSDT Supplemental ServicesProvider Social Work 01/17/2012Heidi C
Rutherford Physician Family Medicine 09/13/2011Rian W
Ruwe Audiologist Audiology 10/10/2012Andrea C
Ryan Physical Therapist Physical Therapy 02/01/1992Mary C
Page 322 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
RyanEPSDT Supplemental ServicesProvider Social Work 04/03/2006Robert L
RyderEPSDT Supplemental ServicesProvider Dietetics 04/10/2006Serena K
Saade Daoud Physical Therapist Physical Therapy 03/21/2006Maria A
sabanganEPSDT Supplemental ServicesProvider Dietetics 06/01/2012ellen rose
SabourinEPSDT Supplemental ServicesProvider Social Work 09/01/1994Phyllis A
SacapanoEPSDT Supplemental ServicesProvider Dietetics 03/22/2000Amy
SaffoldEPSDT Supplemental ServicesProvider Dietetics 01/08/2009Hannah R
SageEPSDT Supplemental ServicesProvider Dietetics 01/25/2010Lorie C
Page 323 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Sager Occupational Therapist Occupational Therapy 04/22/2008Brian M
Sagon-Alcisto Audiologist Audiology 01/06/2010Reynita R
SagutoEPSDT Supplemental ServicesProvider Dietetics 06/25/2010Gloria F
Sakamoto Occupational Therapist Occupational Therapy 10/09/2012Jenee B
SakataEPSDT Supplemental ServicesProvider Social Work 05/11/2006Karen K
SalazarEPSDT Supplemental ServicesProvider Dietetics 12/19/2008Angela R
SalazarEPSDT Supplemental ServicesProvider Social Work 10/29/2008Michelle H
SalazarEPSDT Supplemental ServicesProvider Social Work 06/01/2010Patricia D
Page 324 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SalazarEPSDT Supplemental ServicesProvider Social Work 09/09/2008Ricardo C
Salem Psychologist Psychology 11/01/2005Ronald E
Salenko PhysicianThoracic Surgery: Thoracic andCardiac Surgery 04/20/2007Susan E
SaletelEPSDT Supplemental ServicesProvider Dietetics 06/27/2006Melissa
SalgadoEPSDT Supplemental ServicesProvider Social Work 02/07/2011Ada P
SalgadoEPSDT Supplemental ServicesProvider Social Work 09/24/2009Yvonne R
Salinas Occupational Therapist Occupational Therapy 03/09/2010Amy M
Salwak Speech Therapist Speech Language Pathology 06/24/2009Patti
Page 325 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SalzedoEPSDT Supplemental ServicesProvider Dietetics 01/27/2003Sandra E
SamaniegoEPSDT Supplemental ServicesProvider Social Work 05/04/2007Carina A
Samartha Physical Therapist Physical Therapy 05/08/2009Rebekah
Samuel Speech Therapist Speech Language Pathology 05/08/2007Nicole R
SanchezEPSDT Supplemental ServicesProvider Social Work 05/31/2006Barbara L
Sanchez Audiologist Audiology 01/06/2012Claribelle
Sanchez Audiologist Audiology 11/03/1999Lucia S
SanchezEPSDT Supplemental ServicesProvider Social Work 03/15/2007Maria D
Page 326 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Sanchez-EspinosaEPSDT Supplemental ServicesProvider Social Work 02/01/2007Mary Ann J
Sanchez-GrobEPSDT Supplemental ServicesProvider Social Work 11/18/2008Juanita
Sand Physician Pediatrics 02/01/1993Patricia
Sanders Speech Therapist Speech Language Pathology 09/11/2007Adriana M
Sanders Occupational Therapist Occupational Therapy 08/03/2007Natalie C
SandersonEPSDT Supplemental ServicesProvider Dietetics 02/01/1999Leslie A
Sandhu Audiologist Audiology 04/15/2009Loveleen K
Sandiford Speech Therapist Speech Language Pathology 06/24/2008Givona A
Page 327 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SanfordEPSDT Supplemental ServicesProvider Dietetics 09/01/2010Kimberly J
Sanguino Physical Therapist Physical Therapy 01/23/2012Nicole A
SantillanEPSDT Supplemental ServicesProvider Social Work 10/24/2008Ernesto
Santo Speech Therapist Speech Language Pathology 02/01/1995Dan J
SantosEPSDT Supplemental ServicesProvider Social Work 06/01/1991Milly
Santoyo Physical Therapist Physical Therapy 02/01/1996Ascension P
Saqui Physical Therapist Physical Therapy 06/02/2011Jasmin L
Saravia Physician Pediatrics 01/20/2004Ana D
Page 328 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Sargent Physical Therapist Physical Therapy 05/01/1994Barbara A
Sarino Physician Pediatrics 06/16/2008Melanie E
Sarransingh Physician Family Medicine 10/03/2011Marta
Sartori Speech Therapist Speech Language Pathology 12/27/2011Melissa R
SasakiEPSDT Supplemental ServicesProvider Social Work 11/09/2009Stephen K
SatoEPSDT Supplemental ServicesProvider Dietetics 06/30/2009Jennifer N
Sattar Physician Family Medicine 03/02/2010Sabeen H A
Satterfield Audiologist Audiology 09/06/2011Lisa M
Page 329 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Satzberg Speech Therapist Speech Language Pathology 11/27/2002Marcy L
Saulog Occupational Therapist Occupational Therapy 05/05/2004Sandra S
Saunders Speech Therapist Speech Language Pathology 08/29/2005Jill S
SawayaEPSDT Supplemental ServicesProvider Social Work 10/18/2010Bettina M
SaxtonEPSDT Supplemental ServicesProvider Dietetics 11/04/2005Claire R
SayerstadEPSDT Supplemental ServicesProvider Social Work 11/07/2005Joan M
Schaal Prosthetist Prosthetics 07/19/2011Mark L
Schaden Occupational Therapist Occupational Therapy 05/08/2007Susan W
Page 330 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Schafer Speech Therapist Speech Language Pathology 12/12/2008Crystal L
Schauer Occupational Therapist Occupational Therapy 05/03/2011Erin K
Schauwecker Audiologist Audiology 11/14/2007Emily T
Scheel Physical Therapist Physical Therapy 01/31/2006Theodore R
SchmidtEPSDT Supplemental ServicesProvider Social Work 01/05/2007Emily B
SchmidtEPSDT Supplemental ServicesProvider Social Work 04/02/2008Jeannine R
Schmidt Speech Therapist Speech Language Pathology 05/14/2012Katherine B
SchmidtEPSDT Supplemental ServicesProvider Dietetics 01/02/2008Victoria A
Page 331 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Schneider Occupational Therapist Occupational Therapy 06/08/2009Beth C
Schneider Speech Therapist Speech Language Pathology 10/01/1978Elaine F
Schneider Audiologist Audiology 07/03/2012Kathryn Cullen
Schneider Physician Pathology: Anatomic and Clinical 08/30/2012Ken
SchneiderEPSDT Supplemental ServicesProvider Dietetics 06/25/2010Michel L
SchonhoffEPSDT Supplemental ServicesProvider Social Work 03/03/2008Kelila A
SchrammEPSDT Supplemental ServicesProvider Social Work 12/01/2000Pamela
SchreiberEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 03/30/2011Mary L
Page 332 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Schreiber Psychologist Psychology 05/31/2011Merritt D
Schreuder Audiologist Audiology 10/03/2005Wendy
SchriderEPSDT Supplemental ServicesProvider Social Work 06/01/1997Theresa S
SchroederEPSDT Supplemental ServicesProvider Dietetics 12/01/1997Holly M
SchroepferEPSDT Supplemental ServicesProvider Dietetics 01/25/2000Concetta
SchubertEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/13/2010Lynn E
SchultzEPSDT Supplemental ServicesProvider Dietetics 10/08/2001Lisa
SchultzEPSDT Supplemental ServicesProvider Social Work 07/10/2006Misty L
Page 333 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SchultzeEPSDT Supplemental ServicesProvider Social Work 03/23/2012Nicole D
Schumacher-MakaiEPSDT Supplemental ServicesProvider Social Work 01/13/2012Cora U
Schumaker Physician Family Medicine 09/24/2009Edward W
SchwarbEPSDT Supplemental ServicesProvider Social Work 12/29/2009Andrea C
Schwartz Occupational Therapist Occupational Therapy 12/22/2003Adina P
SchwartzEPSDT Supplemental ServicesProvider Social Work 06/24/2008Jeffrey H
Schwartz Speech Therapist Speech Language Pathology 09/12/2005Karen J
Schwartz Occupational Therapist Occupational Therapy 05/19/2009Kathleen E
Page 334 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SchwartzEPSDT Supplemental ServicesProvider Dietetics 01/08/2009Kristine M
Schwartz Speech Therapist Speech Language Pathology 07/16/2002Nancy S
Schwarz Physical Therapist Physical Therapy 05/01/1999Karen J
SchwenkerEPSDT Supplemental ServicesProvider Dietetics 02/25/2004Keri J
Scott Audiologist Audiology 03/30/2011Amanda S
Scott Occupational Therapist Occupational Therapy 03/09/2010Douglas
ScottEPSDT Supplemental ServicesProvider Dietetics 04/01/1996Elizabeth
Scott Audiologist Audiology 05/27/2003Heather L
Page 335 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ScottEPSDT Supplemental ServicesProvider Dietetics 10/17/2011Mark A
SealEPSDT Supplemental ServicesProvider Social Work 01/17/2008Stephanie D
sebringEPSDT Supplemental ServicesProvider Social Work 07/12/2012ashley
SecheEPSDT Supplemental ServicesProvider Dietetics 02/10/2001Gail
SeguraEPSDT Supplemental ServicesProvider Social Work 09/14/2009Mireya
Sekhon Physician Pediatrics 10/17/2006Rashmi
Sekhon PhysicianPediatrics: Neonatal-PerinatalMedicine 10/26/2009Rashmi
SeldersEPSDT Supplemental ServicesProvider Social Work 11/24/2003Angela J
Page 336 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SelfridgeEPSDT Supplemental ServicesProvider Dietetics 11/10/2010Siu-Ying L
selleEPSDT Supplemental ServicesProvider Social Work 07/06/2012sharon
Selover Physical Therapist Physical Therapy 05/20/2008Amy
Semel Physical Therapist Physical Therapy 08/16/2010Jay I
SenekerEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/19/2001Mary
SengmanyEPSDT Supplemental ServicesProvider Social Work 02/13/2009Khamnga
Senosiain Occupational Therapist Occupational Therapy 02/09/2010Eric M
Sepulveda Occupational Therapist Occupational Therapy 06/18/2009Aviril L
Page 337 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SepulvedaEPSDT Supplemental ServicesProvider Social Work 04/26/2011Dalila F
Serna Physician Pediatrics 09/15/2008Alma R
SernaEPSDT Supplemental ServicesProvider Social Work 11/29/2001Patricia
Serna-Flood Respiratory Care Practitioner Respiratory Care Practice 04/10/2012DeeAnna L
Serrano Physical Therapist Physical Therapy 08/01/1989Christina B
Sethi Physician Pediatrics 02/02/2010Neela Y
Seto Occupational Therapist Occupational Therapy 12/09/2008Jones W
Settelmayer Occupational Therapist Occupational Therapy 09/13/1991Suzanne M
Page 338 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SeveraEPSDT Supplemental ServicesProvider Dietetics 08/07/2012Megan J
SeveranceEPSDT Supplemental ServicesProvider Social Work 06/01/1999Lori J
SevillaEPSDT Supplemental ServicesProvider Dietetics 06/26/2007Terrye W
Sevilla-Bodine Physician Pediatrics 12/08/2009Sharon C
SewakEPSDT Supplemental ServicesProvider Dietetics 06/26/2009Sarika L
SextonEPSDT Supplemental ServicesProvider Social Work 10/12/2005Jamie T
Shabaik Physician Family Medicine 07/24/2012Salma A
Shaban Audiologist Audiology 12/15/1999Helen
Page 339 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ShacketEPSDT Supplemental ServicesProvider Dietetics 02/04/2011Harvey P
Shadrick Physician Pediatrics 02/14/2007Lidia A
Shafa Physician Anesthesiology 12/03/2001Mark M
Shafer AbduEPSDT Supplemental ServicesProvider Social Work 03/09/2009Tiffany M
Shaffer Speech Therapist Speech Language Pathology 02/22/2012Leora A
ShaffronEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/05/2012Janet M
Shah Occupational Therapist Occupational Therapy 06/01/1982Mahendra
ShahEPSDT Supplemental ServicesProvider Dietetics 08/01/2011Mansi V
Page 340 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Shah Physical Therapist Physical Therapy 12/27/2011Sanskriti
Shah Physician Orthopaedic Surgery 03/29/2012Swapnil
Shah Physical Therapist Physical Therapy 12/18/2007Tejal D
Shanfield Occupational Therapist Occupational Therapy 09/09/2009Kathleen J
ShanoianEPSDT Supplemental ServicesProvider Dietetics 10/25/2007Lisa A
ShapatelEPSDT Supplemental ServicesProvider Social Work 11/14/2006Purvi S
Sharma Physician Pediatrics 05/22/2007Anupama
ShawEPSDT Supplemental ServicesProvider Social Work 04/05/2006Barbara L
Page 341 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ShawEPSDT Supplemental ServicesProvider Social Work 01/17/2007Jessica A
Shaw Physical Therapist Physical Therapy 04/08/2009Rachel A
Shaw Huang PhysicianPsychiatry and Neurology: ClinicalNeurophysiology 12/12/2011Susan J
SheaEPSDT Supplemental ServicesProvider Social Work 06/30/2005Melissa B
Shea Prosthetist Prosthetics/Orthotics 10/01/2008William J
Sheeran Physical Therapist Physical Therapy 04/01/1992April D
Sheffer Occupational Therapist Occupational Therapy 07/01/1994Laura
Shelby-Woodard Occupational Therapist Occupational Therapy 05/19/2009Johnya R
Page 342 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Shelton Orthotist Orthotics 04/26/2012Karina V
Shelton Prosthetist Prosthetics 11/21/2011Karina V
Shen Physical Therapist Physical Therapy 04/29/2011Doris H
SherfieldEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 04/17/2012Lindsay A
Sherman Occupational Therapist Occupational Therapy 07/17/2008Ila A
ShermanEPSDT Supplemental ServicesProvider Social Work 06/01/1996Kim
Sherry Physical Therapist Physical Therapy 12/02/2008Deborah C
Sherwood Audiologist Audiology 02/16/2001Jennifer
Page 343 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ShieldsEPSDT Supplemental ServicesProvider Social Work 12/07/2010Suzette L
Shiff Physical Therapist Physical Therapy 12/10/2004Elizabeth A
ShinEPSDT Supplemental ServicesProvider Dietetics 04/23/2009Esther S
ShinedlingEPSDT Supplemental ServicesProvider Social Work 10/28/2010Sharrie L
Shinoda Physical Therapist Physical Therapy 02/10/2006Katherine M
ShinozakiEPSDT Supplemental ServicesProvider Social Work 12/23/2011Marsha K
Shiroma Occupational Therapist Occupational Therapy 07/24/2006Debra M
Shongood Speech Therapist Speech Language Pathology 02/17/2010Lorena
Page 344 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Shorey Occupational Therapist Occupational Therapy 02/04/2008Sharon A
ShortesEPSDT Supplemental ServicesProvider Social Work 12/22/2008Leslyn M
ShourtEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/26/2011Stacy R
ShowalterEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 09/07/2010Jennifer B
Shows Occupational Therapist Occupational Therapy 05/19/2009Erin D
ShreiberEPSDT Supplemental ServicesProvider Social Work 08/21/2007Davida M
Shrout Orthotist Orthotics 11/13/2006Chong
Shrum Speech Therapist Speech Language Pathology 05/01/1982William F
Page 345 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Shuck Physical Therapist Physical Therapy 07/24/2007Stephanie R
Shumaker-HammondEPSDT Supplemental ServicesProvider Social Work 07/07/2010Ariel M
ShumateEPSDT Supplemental ServicesProvider Dietetics 08/29/2006Melissa J
Shuster Physician Pathology: Anatomic 04/10/2012Deborah
SiaEPSDT Supplemental ServicesProvider Social Work 03/15/2011Rex F
SibertsEPSDT Supplemental ServicesProvider Dietetics 02/02/2011Dawn A
Sidel Physical Therapist Physical Therapy 12/09/2005Cheryl L
Sidhu Physician Family Medicine 03/18/2011Paramvir S
Page 346 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Siebern Psychologist Psychology 04/29/2010Allison T
SieboldEPSDT Supplemental ServicesProvider Social Work 06/20/2011Shawna M
Sieckert Physical Therapist Physical Therapy 12/16/2008Erika E
Siegel Physical Therapist Physical Therapy 03/16/2012Jaclyn M
Siffermann Physical Therapist Physical Therapy 06/03/2009Michael J
Siffermann Physical Therapist Physical Therapy 05/08/2009Susan M
Sigurdson Audiologist Audiology 11/07/2011Elyssa J
SilvaEPSDT Supplemental ServicesProvider Social Work 12/07/2010Kathryn J
Page 347 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SilvaEPSDT Supplemental ServicesProvider Social Work 02/28/2011Paris L
SilvaEPSDT Supplemental ServicesProvider Dietetics 10/25/2012Rosibel
SilverEPSDT Supplemental ServicesProvider Social Work 01/19/2010Kara J
Simmons Audiologist Audiology 03/01/2004Slade S
Simpson Speech Therapist Speech Language Pathology 06/15/2007Michael P
SinghEPSDT Supplemental ServicesProvider Dietetics 02/03/2012Ranjana
Singh MD Physician Family Medicine 10/30/2007Amandeep
Sinha Occupational Therapist Occupational Therapy 02/24/2012Anne B
Page 348 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Siqueiros Occupational Therapist Occupational Therapy 10/01/1988Dorothy A
Sisson Prosthetist Prosthetics/Orthotics 07/27/2010Edward F
Sitar Occupational Therapist Occupational Therapy 09/01/1988Connie J
Siu Speech Therapist Speech Language Pathology 10/17/2011Athena S
SkaarEPSDT Supplemental ServicesProvider Dietetics 01/01/1995Janette P
Skemp Occupational Therapist Occupational Therapy 10/24/2008Sheila M
Skilan-ArguetaEPSDT Supplemental ServicesProvider Social Work 02/08/2008Juliann
Skinner Physician Orthopaedic Surgery 08/01/1984Stephen R
Page 349 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Skinner-BeamanEPSDT Supplemental ServicesProvider Social Work 12/11/2007Anna B
Skourup-Rich Audiologist Audiology 01/06/2003Dianne K
Skura Physical Therapist Physical Therapy 03/28/2011Christy L
Slavik Occupational Therapist Occupational Therapy 11/01/1982Betsy
SlenkEPSDT Supplemental ServicesProvider Social Work 10/16/2007Leah B
Smith Audiologist Audiology 06/30/2009Beatrice R
Smith Speech Therapist Speech Language Pathology 03/18/2009Carrie E
SmithEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/05/2010Heather A
Page 350 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SmithEPSDT Supplemental ServicesProvider Social Work 12/29/2011Jackey J
Smith Physician Internal Medicine 12/02/2005James M
Smith Occupational Therapist Occupational Therapy 07/01/1996Janice
Smith Audiologist Audiology 05/02/2001Laurynn
SmithEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/06/2011Leah D
Smith Physical Therapist Physical Therapy 02/01/2008Martha M
SmithEPSDT Supplemental ServicesProvider Social Work 04/05/2007Melanie N
SmithEPSDT Supplemental ServicesProvider Social Work 05/16/2006Michelle M
Page 351 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Smith Physical Therapist Physical Therapy 10/22/2009Mollee H
Smith Physical Therapist Physical Therapy 01/05/2009Paul D
Smith Physical Therapist Physical Therapy 05/08/2009Scott E
Snider Physical Therapist Physical Therapy 11/01/1995Jeanine M
Snider Prosthetist Prosthetics 10/20/2008William B
Snodgrass Audiologist Audiology 10/06/2008Danielle N
SobelEPSDT Supplemental ServicesProvider Social Work 11/01/1995David J
SolanoEPSDT Supplemental ServicesProvider Social Work 09/10/2012Nash Norman
Page 352 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SolisEPSDT Supplemental ServicesProvider Dietetics 02/15/2006Katherine S
SolomonEPSDT Supplemental ServicesProvider Social Work 01/21/2011Cynthia D
SolorioEPSDT Supplemental ServicesProvider Social Work 10/25/2010Sylvia A
SomersEPSDT Supplemental ServicesProvider Social Work 02/26/2008Serena
SongEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/19/2011Cassie
SoobzokovEPSDT Supplemental ServicesProvider Social Work 04/15/2008Michelle
SoodEPSDT Supplemental ServicesProvider Social Work 05/17/2005Anupama R
SophabmixayEPSDT Supplemental ServicesProvider Social Work 07/15/2010Takako
Page 353 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SoppEPSDT Supplemental ServicesProvider Social Work 01/17/2008Kathleen C
Sorensen Occupational Therapist Occupational Therapy 09/18/2007Karen P
Sorgaard Hilton Physical Therapist Physical Therapy 03/06/2002Astri
Sorrell Psychologist Psychology 09/15/2009John T
SosaEPSDT Supplemental ServicesProvider Social Work 02/04/2011Carlos M
SotoEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/14/2011Patricia L
Southgate Physical Therapist Physical Therapy 09/12/2007Carrie E
SowaEPSDT Supplemental ServicesProvider Dietetics 03/01/1995Mary E
Page 354 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Spacagna Audiologist Audiology 09/06/2011Robert A
SpanoEPSDT Supplemental ServicesProvider Dietetics 03/21/2006Gina L
Spayd Audiologist Audiology 04/15/2009Karen A
Spears Audiologist Audiology 08/10/2010Iris E
Spector-ShleiferEPSDT Supplemental ServicesProvider Social Work 05/19/2010Pnina
SpellEPSDT Supplemental ServicesProvider Social Work 08/03/2006Scott M
Spence Physical Therapist Physical Therapy 08/01/1990Susan M
Spencer Audiologist Audiology 01/11/2010Raymond E
Page 355 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Sperling Audiologist Audiology 11/14/2005Michael W
SperryEPSDT Supplemental ServicesProvider Social Work 03/28/2006Lois F
Spickelmier Physical Therapist Physical Therapy 09/01/1992Jane L
Spiller Physician Family Medicine 03/05/2009Bettina U
Spina Physical Therapist Physical Therapy 03/17/2000Noel
Spindle Physical Therapist Physical Therapy 07/15/2008Nicole E
SpitaleEPSDT Supplemental ServicesProvider Dietetics 12/12/2005Frances A
Spitzer Physician Pediatrics 07/01/2002Marsha D
Page 356 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SpolarichEPSDT Supplemental ServicesProvider Social Work 08/04/2004Ed
Spratt Speech Therapist Speech Language Pathology 01/07/2011Julia
SprogerEPSDT Supplemental ServicesProvider Social Work 12/31/2003Steven R
StabileEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/13/2010Renee M
Stacy Physical Therapist Physical Therapy 10/21/2009Barbara J
StahlEPSDT Supplemental ServicesProvider Dietetics 01/20/2012Becky D
Staley Speech Therapist Speech Language Pathology 02/22/2012Jennifer N
Stange Physical Therapist Physical Therapy 02/21/2007Kathleen M
Page 357 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
StantonEPSDT Supplemental ServicesProvider Social Work 04/03/2006Melissa A
Stark Physician Anesthesiology 11/01/2012 10/30/2015Andrea
Stassi Physical Therapist Physical Therapy 11/24/2009Holly E
StebbinsEPSDT Supplemental ServicesProvider Social Work 07/03/2008Natasha G
Steder-MyersEPSDT Supplemental ServicesProvider Social Work 08/22/2006Laura J
SteeleEPSDT Supplemental ServicesProvider Dietetics 09/14/2009Caroline L
Steele Occupational Therapist Occupational Therapy 01/26/2006Deborah K
SteeleEPSDT Supplemental ServicesProvider Social Work 07/28/2008Gregory R
Page 358 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Steele-Major Physical Therapist Physical Therapy 07/27/2012Claudia G
StefanEPSDT Supplemental ServicesProvider Social Work 12/13/2010Julie E
Steien Speech Therapist Speech Language Pathology 04/09/2008Heidi S
Steinberg Speech Therapist Speech Language Pathology 02/04/2004Janet C
SteinerEPSDT Supplemental ServicesProvider Social Work 01/31/2008Mary V
Steinhauser Speech Therapist Speech Language Pathology 08/22/2006Heather E
SterlingEPSDT Supplemental ServicesProvider Social Work 01/23/2012Beth E
Sterling Psychologist Psychology 01/29/2007Jeanne D
Page 359 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
StewartEPSDT Supplemental ServicesProvider Social Work 06/21/2011Marlyna R
StewartEPSDT Supplemental ServicesProvider Social Work 07/29/2008Peggy
Stika Psychologist Psychology 01/06/2010Carren J
StinesenEPSDT Supplemental ServicesProvider Social Work 02/21/2003Karin M
StittiamsEPSDT Supplemental ServicesProvider Social Work 02/01/1987Sheila R
St JamesEPSDT Supplemental ServicesProvider Social Work 11/18/2009Jennifer A
StockEPSDT Supplemental ServicesProvider Social Work 07/22/2008Sondra R
StocktonEPSDT Supplemental ServicesProvider Social Work 12/18/2007Rachel L
Page 360 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Stoltzfus Psychologist Psychology 07/01/2001Carrie
Stone Audiologist Audiology 09/01/2011Christopher L
Stopher Audiologist Audiology 01/11/2001Claire E
Stratton Audiologist Audiology 10/20/2009Veronica J
StreeperEPSDT Supplemental ServicesProvider Dietetics 09/13/2010Christen M
Streeton Physical Therapist Physical Therapy 12/02/2011Amanda K
StricklerEPSDT Supplemental ServicesProvider Social Work 02/04/2011Lisa B
Striez Speech Therapist Speech Language Pathology 05/01/1997Viera R
Page 361 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Strobel-Weiss Audiologist Audiology 08/25/2003Karen L
Studer Prosthetist Prosthetics 05/11/1993Taed M
Studer Prosthetist Prosthetics 05/01/1993Taed M
Stulz Speech Therapist Speech Language Pathology 10/12/2007Brooke M
SturmEPSDT Supplemental ServicesProvider Dietetics 09/22/2000Mary
Su Occupational Therapist Occupational Therapy 07/01/1983Ra-Van
Su Physical Therapist Physical Therapy 10/20/2005Yuan T
SuenEPSDT Supplemental ServicesProvider Dietetics 06/26/2009Liyun F
Page 362 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Sugano-IsaEPSDT Supplemental ServicesProvider Dietetics 03/23/2010Mika
SugimuraEPSDT Supplemental ServicesProvider Dietetics 12/01/1994Linda
SulimanEPSDT Supplemental ServicesProvider Dietetics 08/11/2010Geraldine
Sullivan Audiologist Audiology 03/29/2004Jani K
Sullivan Physician Pediatrics 10/01/1979John J
Sullivan Orthotist Orthotics 06/05/2007Kyle P
SullivanEPSDT Supplemental ServicesProvider Dietetics 05/29/2007Mary P
Sulprizio Speech Therapist Speech Language Pathology 05/01/1998Sandra L
Page 363 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Sumner Physical Therapist Physical Therapy 11/03/2009Sean P
SurberEPSDT Supplemental ServicesProvider Dietetics 08/01/2010Christine
Swancoat Speech Therapist Speech Language Pathology 06/22/2007Maria J
Swartt Occupational Therapist Occupational Therapy 12/15/2006Terry A
Sweeney Physical Therapist Physical Therapy 01/31/2006Stacy N
Sweigart Physical Therapist Physical Therapy 10/01/1991Dolores A
SwiftEPSDT Supplemental ServicesProvider Dietetics 05/16/2011Marilyn A
swift Physician Internal Medicine 04/16/2012upasna M B
Page 364 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Swingle Speech Therapist Speech Language Pathology 03/19/2009Joseph M
Swink Physical Therapist Physical Therapy 08/12/2010David R
Switzer Speech Therapist Speech Language Pathology 04/23/2008Christine L
SydnorEPSDT Supplemental ServicesProvider Social Work 09/07/2010Valerie J
SyedEPSDT Supplemental ServicesProvider Social Work 01/04/2012Fiaz A
Sylvester Occupational Therapist Occupational Therapy 09/01/1995Diana H
SymonsEPSDT Supplemental ServicesProvider Dietetics 02/23/2006Cynthia J
SzelapEPSDT Supplemental ServicesProvider Social Work 12/01/1999Mindy A
Page 365 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
SzerszenEPSDT Supplemental ServicesProvider Social Work 11/12/2008Yoke M
Tackett Speech Therapist Speech Language Pathology 07/14/2006Kristie N
Tadina-SiauEPSDT Supplemental ServicesProvider Social Work 11/09/2006Eleanor
TadokoroEPSDT Supplemental ServicesProvider Social Work 11/09/2009Benjamin H
Taggart Physical Therapist Physical Therapy 07/01/1985Patricia
Taheri Physician Pediatrics 08/21/2007Kamela
Tai Occupational Therapist Occupational Therapy 04/28/2010Jui H
Tai Audiologist Audiology 11/22/2010Yi-Hsin
Page 366 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
TajimaroaEPSDT Supplemental ServicesProvider Social Work 01/09/2009Yadira A
TajimmaroaEPSDT Supplemental ServicesProvider Social Work 01/09/2009Yadira A
TakEPSDT Supplemental ServicesProvider Dietetics 01/24/2012Pura B
Takakura Physical Therapist Physical Therapy 03/26/2004Rie
TakasumiEPSDT Supplemental ServicesProvider Social Work 05/31/2006Yoko
Takeuchi Occupational Therapist Occupational Therapy 01/01/2012Katsumi
Talamantez Speech Therapist Speech Language Pathology 11/13/2008Sara M
TamEPSDT Supplemental ServicesProvider Dietetics 06/15/2007Cecilia F
Page 367 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
TamashiroEPSDT Supplemental ServicesProvider Social Work 03/16/2012Keila
Tanaka Audiologist Audiology 09/01/2001Linda
Tani Occupational Therapist Occupational Therapy 02/26/2007Stacey K
Tantau Audiologist Audiology 07/22/2011Julie A
Tareshawty Occupational Therapist Occupational Therapy 10/29/2009Camille
Taylor Physician Family Medicine 03/10/2009Denise E
TaylorEPSDT Supplemental ServicesProvider Social Work 03/27/2003Etta J
Taylor Audiologist Audiology 10/01/2000Terri M
Page 368 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
TaylorEPSDT Supplemental ServicesProvider Dietetics 01/24/2008Theresa L
Taylor-BrebesEPSDT Supplemental ServicesProvider Social Work 07/25/2006Ellise S
TedlaEPSDT Supplemental ServicesProvider Social Work 04/03/2006Emebet F
Tegerstrand Prosthetist Prosthetics/Orthotics 12/10/2008Justin A
Teitelbaum Audiologist Audiology 04/27/2005Susan P
Teixeira Psychologist Psychology 09/28/2001Jerry
TellEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/26/2010Stasia
TennysonEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 07/26/2000Linda
Page 369 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
TesselEPSDT Supplemental ServicesProvider Social Work 01/13/2004Terza
Test Physical Therapist Physical Therapy 03/27/2006Test
ThaiEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 06/02/2010Quan B
ThakkarEPSDT Supplemental ServicesProvider Social Work 09/24/2009Ammie K
Thatcher Occupational Therapist Occupational Therapy 03/10/2010Ann
TheardEPSDT Supplemental ServicesProvider Social Work 09/22/2010Leslie A
Theesen Physical Therapist Physical Therapy 04/27/2009Adam W
ThomasEPSDT Supplemental ServicesProvider Social Work 09/13/2004Adrienne V
Page 370 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ThomasEPSDT Supplemental ServicesProvider Social Work 03/11/2011April L
Thomas Occupational Therapist Occupational Therapy 05/23/2011Kathleen M
ThomasEPSDT Supplemental ServicesProvider Social Work 03/13/2006Stephen M
Thomason Physical Therapist Physical Therapy 06/08/2009Heather K
Thompson Psychologist Psychology 04/29/2010Allison L
Thompson Speech Therapist Speech Language Pathology 11/18/2009Anne S
Thompson Psychologist Psychology 05/01/2007Dolores G
ThompsonEPSDT Supplemental ServicesProvider Dietetics 07/13/2006Jacqueline A
Page 371 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ThompsonEPSDT Supplemental ServicesProvider Social Work 02/23/2009Jewel C
Thorn Occupational Therapist Occupational Therapy 06/01/1988Marianna
ThrasherEPSDT Supplemental ServicesProvider Social Work 07/14/2011Tia L
Throp Audiologist Audiology 12/20/2010Michelle
Tidwell Speech Therapist Speech Language Pathology 08/18/2010Allison E
TienEPSDT Supplemental ServicesProvider Social Work 08/07/2007Jenny W
TierneyEPSDT Supplemental ServicesProvider Social Work 10/11/2010Amy S
Tifa Occupational Therapist Occupational Therapy 08/25/2008Ivory D
Page 372 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Tillett Occupational Therapist Occupational Therapy 11/13/2012Joan A
TiltonEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/25/2004Nicole M
Timm Psychologist Psychology 06/30/2006Janice R
Timme Physician Pediatrics 07/06/2012Rebecca
TindleEPSDT Supplemental ServicesProvider Dietetics 09/26/2007Debra L
tingEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/30/2012janet
TinsleyEPSDT Supplemental ServicesProvider Social Work 10/09/2008Juanita H
Tioleco-Cheng Physician Pediatrics 02/11/2008Melanie G
Page 373 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Tipton Physical Therapist Physical Therapy 05/08/2009Lydia M
Tipton-Burton Occupational Therapist Occupational Therapy 12/16/2005Michelle M
Tobase Physical Therapist Physical Therapy 03/01/1996Patricia M
ToddEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 11/16/2007Frances E
TokunagaEPSDT Supplemental ServicesProvider Social Work 04/01/1998Janis B
Tolentino Physical Therapist Physical Therapy 05/01/2012Nanet G
TomczakEPSDT Supplemental ServicesProvider Social Work 10/28/2011Margaret J
TomlinsonEPSDT Supplemental ServicesProvider Dietetics 07/28/2007Kevin L
Page 374 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
TomsEPSDT Supplemental ServicesProvider Dietetics 05/23/2006Tracy L
Tong Physical Therapist Physical Therapy 04/01/1994Deborah C
Torburn Physical Therapist Physical Therapy 03/09/2012Leslie
Toro-MirandaEPSDT Supplemental ServicesProvider Dietetics 08/03/2007Yvonne A
TorresEPSDT Supplemental ServicesProvider Social Work 01/14/2008Laurie R
TorresEPSDT Supplemental ServicesProvider Social Work 12/30/2011Nadia I
TorresEPSDT Supplemental ServicesProvider Social Work 06/08/2009Nancy M
Torres Speech Therapist Speech Language Pathology 09/01/1987Rachel
Page 375 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Totilo Physical Therapist Physical Therapy 05/13/2008Jeanine M
Totten Speech Therapist Speech Language Pathology 07/14/2010Leah R
Towne-MerrittEPSDT Supplemental ServicesProvider Dietetics 08/12/1999Mary J
TownesEPSDT Supplemental ServicesProvider Social Work 06/06/2011Stacy M
Townsend Occupational Therapist Occupational Therapy 07/26/2012Danielle M
Townsend Occupational Therapist Occupational Therapy 11/10/2009Marian K
Traina Speech Therapist Speech Language Pathology 08/01/2001Carolyn J
Trainer Orthotist Orthotics 09/20/2005Regina L
Page 376 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Tran Occupational Therapist Occupational Therapy 08/21/2012Janette M
TranEPSDT Supplemental ServicesProvider Social Work 12/20/2006Kim L
Tran Physical Therapist Physical Therapy 12/16/2008Lisa M
Tran Physical Therapist Physical Therapy 10/28/2005Trinh M
Trapse Physician Family Medicine 01/08/2007Jr
Trapsi Speech Therapist Speech Language Pathology 12/22/2006Aimee M
TraversiEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/10/2011Renee L
TravisEPSDT Supplemental ServicesProvider Social Work 04/21/2006Roosevelt
Page 377 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Tremmel-Howell Audiologist Audiology 05/31/2002Kelly
Tribble Audiologist Audiology 10/10/2007Melissa S
Trim Psychologist Psychology 03/23/2010Ryan S
Trizuto Physical Therapist Physical Therapy 05/02/2007Jennifer L
Trondsen Speech Therapist Speech Language Pathology 02/01/1985Lisa A
Trost-Cardamone Speech Therapist Speech Language Pathology 04/01/1986Judith
Trowbridge Occupational Therapist Occupational Therapy 11/17/2009Todd C
TrowerEPSDT Supplemental ServicesProvider Social Work 02/27/2012Margery A
Page 378 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Truman Prosthetist Prosthetics/Orthotics 08/12/2011Heidi A
TruongEPSDT Supplemental ServicesProvider Social Work 01/01/1996Sandra
TryonEPSDT Supplemental ServicesProvider Dietetics 04/05/2007Maria M
Trythall Audiologist Audiology 04/24/2006Michael R
TsaoEPSDT Supplemental ServicesProvider Social Work 05/17/2010Eric C
Tsui Physical Therapist Physical Therapy 08/24/2006Annie S
Tsui Physical Therapist Physical Therapy 07/13/2004David T
Tu Audiologist Audiology 03/27/2000Clara
Page 379 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
TullierEPSDT Supplemental ServicesProvider Dietetics 07/21/2008Danielle M
Tures Audiologist Audiology 12/05/2008Cathleen R
TurnerEPSDT Supplemental ServicesProvider Social Work 10/29/2012Margarita
Turner Orthotist Orthotics 10/23/2007Mark G
Turrietta Audiologist Audiology 05/31/2002Analisa R
Tweed Physical Therapist Physical Therapy 01/16/2007Jessica L
TwombleyEPSDT Supplemental ServicesProvider Dietetics 05/02/2007Rebecca L
TwumEPSDT Supplemental ServicesProvider Social Work 04/25/2006Lily K
Page 380 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
UhEPSDT Supplemental ServicesProvider Dietetics 08/22/2011Won
Ulibarri Physician Family Medicine 03/16/2007Laura B
Umali Physical Therapist Physical Therapy 03/03/2009Wendi L
Urbonas Speech Therapist Speech Language Pathology 02/01/2000Barbara J
Urgiles Psychologist Psychology 08/29/2007Noemi J
UrquizuEPSDT Supplemental ServicesProvider Social Work 12/01/1990Henry V
Uzunyan Physician Pediatrics 12/01/1997Merujan Y
Uzunyan Physician Pediatrics: Pediatric Cardiology 10/03/2007Merujan Y
Page 381 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Vaclavik Orthotist Orthotics 07/18/2002Charles
Vafi Speech Therapist Speech Language Pathology 04/02/2002Holly
VahanvatyEPSDT Supplemental ServicesProvider Dietetics 03/01/2008Umme Salma M
ValcarcelEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 06/17/2010Tara L
Valdez Physical Therapist Physical Therapy 05/12/2011Kathryn L
ValdiviaEPSDT Supplemental ServicesProvider Social Work 09/08/2006Luis A
ValentineEPSDT Supplemental ServicesProvider Social Work 02/17/2004Amy
Valentine Physician Obstetrics and Gynecology 03/19/2012 03/18/2015Cord
Page 382 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ValenzuelaEPSDT Supplemental ServicesProvider Social Work 09/27/2011Lori L
ValenzuelaEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 05/23/2012Patricia Ann
Valerio Physical Therapist Physical Therapy 03/03/1999Armando I
ValleEPSDT Supplemental ServicesProvider Social Work 03/21/2011Priscilla A
Vallejo Agredano Physician Family Medicine 11/04/2009Maria E
Van Beever Physician Pediatrics 08/18/2011William T
Vanderkar Physical Therapist Physical Therapy 07/29/2008Alisa J
Vander MeerEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/23/2012Shirley J
Page 383 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Vander Veen Speech Therapist Speech Language Pathology 08/25/2009Alison M
Van Der Velde Physician Pediatrics 08/13/2007Liesbeth
Van Houtryve Physical Therapist Physical Therapy 09/20/2011Laura B
Van Hulst-LeverEPSDT Supplemental ServicesProvider Social Work 05/01/1999Jacqueline
Vanides Audiologist Audiology 03/12/2007Emily L
Van Laar Speech Therapist Speech Language Pathology 04/20/2004Cynthia J
Van RooyenEPSDT Supplemental ServicesProvider Dietetics 01/25/2010Kristen M
Van StrienEPSDT Supplemental ServicesProvider Social Work 12/27/2007Carolee P
Page 384 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Vaquero Solans Physician Pediatrics 01/11/2008Cecilia
VargasEPSDT Supplemental ServicesProvider Social Work 09/25/2009Micaela
Vargas-RicoEPSDT Supplemental ServicesProvider Social Work 03/16/2009Martha
VargoEPSDT Supplemental ServicesProvider Social Work 03/28/2006Nancy J
VarteressianEPSDT Supplemental ServicesProvider Social Work 08/03/2006Roozan
Vasan Physician Pediatrics 07/01/1997Rukmani
VasquezEPSDT Supplemental ServicesProvider Social Work 06/01/2000Adele M
Vasquez Speech Therapist Speech Language Pathology 11/30/2010Irene L
Page 385 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
VasquezEPSDT Supplemental ServicesProvider Dietetics 06/26/2007Laura L
VasquezEPSDT Supplemental ServicesProvider Dietetics 11/13/2006Veronica L
Vaughan Physician Family Medicine 09/13/2011Gregory G
VaughnEPSDT Supplemental ServicesProvider Social Work 02/07/2011Karmyn B
Vazquez Physician Pediatrics 10/10/2006Eugenio
VegaEPSDT Supplemental ServicesProvider Social Work 04/29/2003Ana M
Vega-TovarEPSDT Supplemental ServicesProvider Social Work 01/02/2007Kathya
Velasco Audiologist Audiology 10/06/2004Doris P
Page 386 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Vella Occupational Therapist Occupational Therapy 09/30/2011Jenelle M
Venturi Speech Therapist Speech Language Pathology 01/25/2010Sarah L
Verghese Physical Therapist Physical Therapy 07/19/2002Annie
VerhinesEPSDT Supplemental ServicesProvider Social Work 02/13/2009Summer J
VeriginEPSDT Supplemental ServicesProvider Social Work 04/05/2007Tanya S
VermaEPSDT Supplemental ServicesProvider Dietetics 03/06/2007Anjali
Vermeulen Speech Therapist Speech Language Pathology 03/18/2010Rosalyn A
Vernon Audiologist Audiology 07/09/2007Tammieh L
Page 387 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Vestal Physical Therapist Physical Therapy 07/19/2010Erin R
Vicas Occupational Therapist Occupational Therapy 02/28/2003Claudia
VicedoEPSDT Supplemental ServicesProvider Social Work 02/27/2012Lelalee C
Vierra Occupational Therapist Occupational Therapy 02/10/2006Tiffany A
VillaEPSDT Supplemental ServicesProvider Social Work 02/11/2008Christina B
VillafuerteEPSDT Supplemental ServicesProvider Social Work 09/27/2012Marisa N
Villalobos Physician Family Medicine 10/29/2008Joe
Villanueva Prosthetist Prosthetics/Orthotics 05/18/2005Felipe D
Page 388 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
VillasenorEPSDT Supplemental ServicesProvider Social Work 11/18/1999Maria
VillasenorEPSDT Supplemental ServicesProvider Social Work 06/30/2006Sylvia P
Villegas Physical Therapist Physical Therapy 10/29/2012Alexandra V
Villegas-McPetersEPSDT Supplemental ServicesProvider Social Work 10/23/1997Deonna
Vincent Psychologist Psychology 11/30/1999PhD
Violanti Audiologist Audiology 10/01/2000Mary Ellen
Violette Speech Therapist Speech Language Pathology 10/14/2010Janice R
ViramontesEPSDT Supplemental ServicesProvider Social Work 02/18/2011Patricia
Page 389 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Visocnik Occupational Therapist Occupational Therapy 10/06/2005Fiona M
VoEPSDT Supplemental ServicesProvider Social Work 04/06/2012Krista M
Vocalino Physical Therapist Physical Therapy 02/02/2012Jennifer
Voelz Physical Therapist Physical Therapy 03/20/2012Kimberley K
VogelEPSDT Supplemental ServicesProvider Social Work 01/30/2008Heather M
VoigtEPSDT Supplemental ServicesProvider Social Work 10/19/2009Sarah
Vovakes Physician Pediatrics 07/01/1981Michael
VueEPSDT Supplemental ServicesProvider Social Work 04/23/2010Cha
Page 390 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Vuletich Orthotist Orthotics 04/12/2000William
Wade Physician Pediatrics 11/16/2007Alexander C
Wadekamper Orthotist Orthotics 04/15/2008Michael J
Wade-Kempiak Physician Pediatrics 09/29/2008Kristen
WagesEPSDT Supplemental ServicesProvider Dietetics 01/21/2010Stephanie E
wagnerEPSDT Supplemental ServicesProvider Social Work 07/10/2012carolee
Wagner Physical Therapist Physical Therapy 02/21/2008Lorrie A
WagnerEPSDT Supplemental ServicesProvider Dietetics 07/06/2005Myra M
Page 391 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Wahl-Anderson Speech Therapist Speech Language Pathology 08/27/2002Bethany Elaine
Wahlquist Speech Therapist Speech Language Pathology 05/24/2006Michelle L
WakeEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 12/20/2005Lynn R
WakefieldEPSDT Supplemental ServicesProvider Social Work 02/04/2010Angela G
Wakefield Speech Therapist Speech Language Pathology 12/12/2006Emily J
Walker Occupational Therapist Occupational Therapy 02/18/2010Cheryl R
Walker Speech Therapist Speech Language Pathology 05/11/2010Danielle R
WalkerEPSDT Supplemental ServicesProvider Social Work 10/09/2008Heidi A
Page 392 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Walker Speech Therapist Speech Language Pathology 01/12/2012Lori S
WallEPSDT Supplemental ServicesProvider Social Work 01/17/2008Camille B
WallaceEPSDT Supplemental ServicesProvider Dietetics 04/27/2009Ann R
Wallace Speech Therapist Speech Language Pathology 10/20/2009Kayla M
WallaceEPSDT Supplemental ServicesProvider Dietetics 04/17/2007Laurie J
WanEPSDT Supplemental ServicesProvider Dietetics 07/21/2006Ning
Wang Physician Pediatrics 03/07/2008Connie S
Wanlass Psychologist Psychology 06/01/1992Richard L
Page 393 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
WansingEPSDT Supplemental ServicesProvider Social Work 01/18/2006Susan
WapenskyEPSDT Supplemental ServicesProvider Dietetics 01/01/1995Tanya J
WarfieldEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/23/2012Chandra lynn
WarnerEPSDT Supplemental ServicesProvider Social Work 04/11/2006Amy L
Warner Psychologist Psychology 12/31/2008Juliet L
Warner Physical Therapist Physical Therapy 08/25/2006Lisa R
Warren Physical Therapist Physical Therapy 01/26/2010Christopher J
WarrenEPSDT Supplemental ServicesProvider Social Work 12/01/1999Ewa J
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LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
WasherEPSDT Supplemental ServicesProvider Social Work 05/22/2006Robert D
Watson Audiologist Audiology 05/31/2002Stephanie
WatsonEPSDT Supplemental ServicesProvider Social Work 12/13/2004Sylvia M
Weagant Physician Family Medicine 12/14/2004Lance W
WeatherfordEPSDT Supplemental ServicesProvider Dietetics 02/03/2009Julie I
Webb Physician Pediatrics 03/18/2008James G
WebbEPSDT Supplemental ServicesProvider Dietetics 08/01/2011Jennifer D
WebbEPSDT Supplemental ServicesProvider Social Work 06/27/2006Ronald L
Page 395 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
WeberEPSDT Supplemental ServicesProvider Dietetics 05/08/2007Gina T
WecksteinEPSDT Supplemental ServicesProvider Social Work 06/01/1999Julie
WeidemanEPSDT Supplemental ServicesProvider Dietetics 01/29/2009Pamela M
Weiner-Kahn Speech Therapist Speech Language Pathology 03/01/1988Sheila B
WeinreichEPSDT Supplemental ServicesProvider Social Work 03/10/2003Heidi M
WeirEPSDT Supplemental ServicesProvider Dietetics 08/25/2009Kathy P
WeiserEPSDT Supplemental ServicesProvider Social Work 06/29/2006Rochelle M
WeisingerEPSDT Supplemental ServicesProvider Social Work 06/15/2007Jessica A
Page 396 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Weisman Physical Therapist Physical Therapy 10/11/2005Amy C
Weiss Physician Family Medicine 09/11/2006Taema
WeissmannEPSDT Supplemental ServicesProvider Social Work 02/15/2006Karen L
WellsEPSDT Supplemental ServicesProvider Dietetics 05/12/2010Pamela S
Welms Audiologist Audiology 08/20/2007Lisa
Wen Audiologist Audiology 11/03/1999Karen
WengEPSDT Supplemental ServicesProvider Social Work 03/03/2009Linda Y
Werner Occupational Therapist Occupational Therapy 10/11/2006Stephanie D
Page 397 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Wessel Physical Therapist Physical Therapy 04/16/2003Deborah J
West Speech Therapist Speech Language Pathology 02/08/2011Juliette S
West Psychologist Psychology 10/03/2006Radmila M
WestfallEPSDT Supplemental ServicesProvider Social Work 08/03/2006Annemarie
Wheeler Speech Therapist Speech Language Pathology 06/22/2011Crystal M
Wheeler Speech Therapist Speech Language Pathology 04/01/1997Kathleen
WheelerEPSDT Supplemental ServicesProvider Social Work 01/26/2009Kevin
White Speech Therapist Speech Language Pathology 01/05/2011Alison M
Page 398 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
White Speech Therapist Speech Language Pathology 03/26/2012Janice M
White Occupational Therapist Occupational Therapy 07/12/2006Jeanine F
White Audiologist Audiology 08/01/1999Jeanne M
White Audiologist Audiology 04/15/2009Linda A
White Speech Therapist Speech Language Pathology 08/29/2005Lindsay
White Audiologist Audiology 05/31/2002Matthew S
White Physical Therapist Physical Therapy 03/21/2011Sharon T
White-Dinkel Speech Therapist Speech Language Pathology 02/23/2011Sarah C
Page 399 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
White-MillerEPSDT Supplemental ServicesProvider Social Work 05/24/2005B T
WhittinghamEPSDT Supplemental ServicesProvider Social Work 09/30/2008Paula L
WichtermanEPSDT Supplemental ServicesProvider Social Work 07/19/2010Lauren J
Wiedeman Physical Therapist Physical Therapy 09/12/2011Lisa M
Wiers Speech Therapist Speech Language Pathology 03/20/2009Cheryl D
Wiggin Speech Therapist Speech Language Pathology 02/15/2006Mallene P
Wilcox Audiologist Audiology 06/08/2004Robert
Wilder Psychologist Psychology 07/12/2007Beem C
Page 400 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Wilkens Physical Therapist Physical Therapy 08/10/2011Patrick
Wilkens Psychologist Psychology 12/30/2005Susan L
Wilkes Psychologist Psychology 05/01/1979 11/01/2011James C
WilkesEPSDT Supplemental ServicesProvider Social Work 04/18/2006Robert S
Wilkins Occupational Therapist Occupational Therapy 07/14/2006Melody M
WillensEPSDT Supplemental ServicesProvider Social Work 01/02/2003Jane A
Willhalm Occupational Therapist Occupational Therapy 03/16/2012Sarah A
Williams Psychologist Psychology 02/21/2006Charlene L
Page 401 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
WilliamsEPSDT Supplemental ServicesProvider Social Work 12/11/2003Cornelis R
Williams Psychologist Psychology 11/10/2011Eshawn D
Williams Physical Therapist Physical Therapy 09/26/2011Gillian
Williams Occupational Therapist Occupational Therapy 04/02/2004Heidi G
Williams Physician Anesthesiology 06/22/2006Steven D
WilliamsEPSDT Supplemental ServicesProvider Dietetics 09/24/2012Tamal L
WilliamsEPSDT Supplemental ServicesProvider Social Work 08/23/2010Veronica S
WilliamsonEPSDT Supplemental ServicesProvider Social Work 08/02/2011Alison A
Page 402 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Williams-Shipman Physical Therapist Physical Therapy 08/10/2007Kari L
Willis Physician Family Medicine 09/07/2010Daniel L
Willis Speech Therapist Speech Language Pathology 04/03/2012Joyce
WillisEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 08/13/2010Valerie L
Willmore Physical Therapist Physical Therapy 10/28/2008Jamie D
Willow Speech Therapist Speech Language Pathology 08/01/1993Lori Ann
WillsEPSDT Supplemental ServicesProvider Dietetics 05/01/2003Leslie H
WillsonEPSDT Supplemental ServicesProvider Dietetics 02/27/2012Lucia M
Page 403 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
wilnerEPSDT Supplemental ServicesProvider Social Work 04/01/1997eileen
WilsonEPSDT Supplemental ServicesProvider Dietetics 01/26/2012Alyssa K
WilsonEPSDT Supplemental ServicesProvider Social Work 11/27/2007Chelsea L
WilsonEPSDT Supplemental ServicesProvider Dietetics 07/05/2001Karen E
Wilson Speech Therapist Speech Language Pathology 08/24/2010Michelle M
Wilson-MartinEPSDT Supplemental ServicesProvider Social Work 05/23/2007Marshiq L
Wiltz Audiologist Audiology 05/24/2010Linda K
winerEPSDT Supplemental ServicesProvider Social Work 07/06/2012karen
Page 404 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Wing Speech Therapist Speech Language Pathology 09/20/2010Pamela D
Winkle Physician Pediatrics 11/02/2011Taryn L
WinterEPSDT Supplemental ServicesProvider Dietetics 08/06/2012Lilia B
Winzelberg Audiologist Audiology 11/30/1999Jody
WisnerEPSDT Supplemental ServicesProvider Social Work 05/18/2010Jennifer A
WithopEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 01/13/2003Ilana
Wojtkiewicz Physical Therapist Physical Therapy 06/12/2002Margaret
WolfEPSDT Supplemental ServicesProvider Social Work 10/11/2006Jo U
Page 405 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Wolf Physical Therapist Physical Therapy 02/24/2012Leah Z
WolfeEPSDT Supplemental ServicesProvider Social Work 02/15/2011Aryn R
Wolfe PhysicianPsychiatry and Neurology:Psychiatry 05/30/2012Laura
Wolfgang Speech Therapist Speech Language Pathology 03/22/2005Amanda B
Wondergem Occupational Therapist Occupational Therapy 05/19/2011Christine L
Wong Occupational Therapist Occupational Therapy 06/18/2009Alice
WongEPSDT Supplemental ServicesProvider Social Work 08/03/2006Deborah Y
Wong Physical Therapist Physical Therapy 03/27/2007Elizabeth E
Page 406 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
WongEPSDT Supplemental ServicesProvider Social Work 12/01/2005Gabriel
Wong Occupational Therapist Occupational Therapy 01/16/2007Irene
Wong Audiologist Audiology 10/06/2008Julia K
WongEPSDT Supplemental ServicesProvider Dietetics 05/01/1995Lonnie K
WongEPSDT Supplemental ServicesProvider Social Work 03/23/2009Miriam M
Wong Physician Pediatrics 05/15/2007Vivian W
Wong-KimEPSDT Supplemental ServicesProvider Social Work 07/10/2012Evaon
Woo Psychologist Psychology 07/13/2009Ellen
Page 407 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
WooEPSDT Supplemental ServicesProvider Dietetics 01/26/2012Melinda D
Wood Physical Therapist Physical Therapy 11/08/2010Courteney P
WoodEPSDT Supplemental ServicesProvider Social Work 02/04/2011Joan R
Wood Physical Therapist Physical Therapy 05/08/2009Michelle S
WoodardEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/16/2011Natalie P
WoodmanseeEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 01/04/2012Jennifer H
WoodsEPSDT Supplemental ServicesProvider Social Work 03/16/2010Cathryn
Woon Speech Therapist Speech Language Pathology 10/17/2006Irene
Page 408 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Worley Speech Therapist Speech Language Pathology 04/21/2008Regina K
WormaldEPSDT Supplemental ServicesProvider Dietetics 06/11/2003Regina J
WortiskaEPSDT Supplemental ServicesProvider Dietetics 01/13/2009Emily S
WrightEPSDT Supplemental ServicesProvider Dietetics 04/13/2007Kimberly C
WrightEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/31/2012Mary C
WrightEPSDT Supplemental ServicesProvider Social Work 05/22/2006Samantha A
Wroolie Psychologist Psychology 05/01/2007Tonita E
WuEPSDT Supplemental ServicesProvider Social Work 06/29/2006Angela P
Page 409 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Wu Physician Pediatrics 12/04/2007Katherine S
Wy Physician Pediatrics 02/01/2001Cherry
WyniaEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 02/02/2012Sarbelia D
WysongEPSDT Supplemental ServicesProvider Dietetics 02/15/2006Holley E
Xiong Occupational Therapist Occupational Therapy 04/11/2006Fei
Xu Physician Family Medicine 04/12/2009Weimin
Yager Speech Therapist Speech Language Pathology 03/23/2012Blair E
Yamaguchi Physician Surgery: (general) 01/24/2012Miles J
Page 410 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
YamamotoEPSDT Supplemental ServicesProvider Social Work 07/01/1998Anthony
Yamamoto Prosthetist Prosthetics/Orthotics 12/14/2006Garry M
YamamotoEPSDT Supplemental ServicesProvider Dietetics 01/01/2004Susan R
Yamasaki Occupational Therapist Occupational Therapy 05/19/2009Alice K
YancyEPSDT Supplemental ServicesProvider Social Work 03/17/2011Alyse B
Yandall Occupational Therapist Occupational Therapy 08/25/2003Kaliko
YarbroughEPSDT Supplemental ServicesProvider Social Work 05/17/2004Arielle
YashizakiEPSDT Supplemental ServicesProvider Social Work 08/01/1994Amy M
Page 411 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
YbarraEPSDT Supplemental ServicesProvider Social Work 07/07/2010Adriana C
Ybarra Physical Therapist Physical Therapy 01/31/2012Tawni J
YeatonEPSDT Supplemental ServicesProvider Social Work 12/30/2005Joanne M
YedinakEPSDT Supplemental ServicesProvider Registered Nurse/PNP (SCC only) 10/13/2010Elsa M
Yee Physician Family Medicine 09/29/2009Veronica
YefskyEPSDT Supplemental ServicesProvider Social Work 10/01/1995Garry D
Yekrangi Physical Therapist Physical Therapy 04/13/2007Armaghan A
Yen-SadoffEPSDT Supplemental ServicesProvider Social Work 10/01/1992Mina L
Page 412 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Yerkey Physical Therapist Physical Therapy 03/17/2005Jennifer E
Yetter Occupational Therapist Occupational Therapy 10/06/2009Kyle P
Ylescupidez Physician Pediatrics 09/04/2007Liza Marie
YooEPSDT Supplemental ServicesProvider Dietetics 11/14/2006Angel S
York Physical Therapist Physical Therapy 02/02/2006Joann K
Young Speech Therapist Speech Language Pathology 04/10/2012Courtney E
Young Prosthetist Prosthetics/Orthotics 08/23/2006Douglas R
Young Physical Therapist Physical Therapy 08/31/2012Ilka Johanna
Page 413 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Young Speech Therapist Speech Language Pathology 08/10/2006Joyce C
YoungEPSDT Supplemental ServicesProvider Social Work 02/14/2007Marlon
YoungEPSDT Supplemental ServicesProvider Dietetics 10/10/1997Pamela A
Young-LoweEPSDT Supplemental ServicesProvider Social Work 01/05/2009Karyn
YoungquistEPSDT Supplemental ServicesProvider Social Work 08/01/1994Rod G
Yuille Audiologist Audiology 05/17/2011Carolyn C
Yun Occupational Therapist Occupational Therapy 09/23/2008Cathy S
Yun Occupational Therapist Occupational Therapy 06/03/2010Hubert H
Page 414 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Yun PhysicianPsychiatry and Neurology:Addiction Psychiatry 10/23/2012Thomas
Yun PhysicianPsychiatry and Neurology:Psychiatry 10/23/2012Thomas
Yung Physician Internal Medicine 03/22/2010Doris
Yung Physician Pediatrics 03/22/2010Doris
Zacharius-DaharshEPSDT Supplemental ServicesProvider Social Work 04/01/1998Erica J
Zack Psychologist Psychology 05/19/2010Sanno E
ZagoritesEPSDT Supplemental ServicesProvider Dietetics 05/08/2003Deana J
Zarrabian Psychologist Psychology 05/04/2011Simin
Page 415 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
ZavalaEPSDT Supplemental ServicesProvider Dietetics 07/31/2009Laura S
Zaytsev Psychologist Psychology 05/24/2010Ludmila
Zeisler Physical Therapist Physical Therapy 08/13/2012Cristen M
Zeller Speech Therapist Speech Language Pathology 03/01/1996Donna M
Zellman-SteenEPSDT Supplemental ServicesProvider Social Work 11/06/2007Shyla T
Zemanek Occupational Therapist Occupational Therapy 09/14/2010Kimberly A
Zerda Physician Pediatrics 11/15/2010Maita B
Zetterbaum Speech Therapist Speech Language Pathology 04/21/2009Milia S
Page 416 of 41712/15/12 6:35 PM
LastName ProviderType Specialty EffectiveDt ExpirationDFirstName MiddleNam
Zhang Physician Internal Medicine 07/13/2007Xiao-Ling
Zhu Physician Family Medicine 08/11/2009Yong-De
ZiekeEPSDT Supplemental ServicesProvider Social Work 09/10/2012Janice M
Ziomek Physical Therapist Physical Therapy 08/07/2008Lisa J
Zobac Physical Therapist Physical Therapy 08/28/2006Susan G
Zohba Occupational Therapist Occupational Therapy 12/21/2005Tonya
Zwald Occupational Therapist Occupational Therapy 12/01/1982Kathryn
ZwickerEPSDT Supplemental ServicesProvider Dietetics 06/15/2012Geraldine
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