MEDICARE: JESSICA GARTNER LCSW

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	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	CSW.09925756	CO
3	1041C0700X	Clinical Social Worker	LCSW.09925756	CO

General Provider Information

NPI Number	:	1043622806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GARTNER LCSW

Provider Business Mailing Address
First Line	:	1515 FLORIDA DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-2440
Country	:	US
Telephone Number	:	303-525-3110
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 FLORIDA DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-2440
Country	:	US
Telephone Number	:	303-525-3110
Fax Number	:

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

Provider Enumeration Date	:	05/28/2014
Last Update Date	:	06/26/2024

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