MEDICARE: KIMBERLY ANNE SUTHERLAND M.ED, CAC III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1707-01	CO

General Provider Information

NPI Number	:	1003242611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNE SUTHERLAND M.ED, CAC III

Provider Business Mailing Address
First Line	:	2105 E VIRGINIA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-2721
Country	:	US
Telephone Number	:	720-324-0008
Fax Number	:

Provider Business Practice Location Address
First Line	:	1960 S SHERMAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4014
Country	:	US
Telephone Number	:	720-324-0008
Fax Number	:

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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