MEDICARE: MARIA DAWN HENSON CSW

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	1041C0700X	Clinical Social Worker	CSW.09928036	CO

General Provider Information

NPI Number	:	1245987510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA DAWN HENSON CSW

Provider Business Mailing Address
First Line	:	2220 MAPLE HILL DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2663
Country	:	US
Telephone Number	:	310-753-7979
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 MAPLE HILL DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2663
Country	:	US
Telephone Number	:	310-753-7979
Fax Number	:

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

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/07/2022

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