california children services paneled non pmf provider · pdf file ·...

417
California Children Services Paneled Non PMF Provider Report LastName ProviderType Specialty EffectiveDt ExpirationD FirstName MiddleNam Abbey Psychologist Psychology 11/08/2007 Richard D Abbott Physician Pediatrics 06/20/2005 Lara Abbott EPSDT Supplemental Services Provider Social Work 08/03/2004 Yuko K Abdelghani Physical Therapist Physical Therapy 05/08/2009 Samer S Abeles Speech Therapist Speech Language Pathology 02/09/2010 Linda K Abe-Woolridge Occupational Therapist Occupational Therapy 01/07/1979 Sandra Abriam EPSDT Supplemental Services Provider Social Work 04/06/2006 Nerissa L Page 1 of 417 12/15/12 6:35 PM

Upload: ngokhanh

Post on 19-Mar-2018

216 views

Category:

Documents


2 download

TRANSCRIPT

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

Page 394 of 41712/15/12 6:35 PM

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

Page 417 of 41712/15/12 6:35 PM