MEDICARE: MR. JASON GREGORY STAHNKE 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	1041C0700X	Clinical Social Worker	CSW.09923904	CO
2	1041C0700X	Clinical Social Worker	0009920176	CO
3	1041C0700X	Clinical Social Worker	2015019167	MO
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1285008391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON GREGORY STAHNKE LCSW

Provider Business Mailing Address
First Line	:	6105 S MAIN ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-5360
Country	:	US
Telephone Number	:	720-448-7820
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 S MAIN ST STE 200
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-5361
Country	:	US
Telephone Number	:	720-448-7820
Fax Number	:

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	06/17/2021

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