MEDICARE: DR. ANN LADD PHD, 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	992927	CO
2	1041C0700X	Clinical Social Worker	3270	OR

General Provider Information

NPI Number	:	1316080112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN LADD PHD, LCSW

Provider Business Mailing Address
First Line	:	257 S MANGRUM PL
Second Line	:	PO BOX 7164
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-3636
Country	:	US
Telephone Number	:	719-647-1746
Fax Number	:

Provider Business Practice Location Address
First Line	:	279 S JOE MARTINEZ BLVD
Second Line	:
City	:	PUEBLO WEST
State	:	CO
Zip	:	81007-5439
Country	:	US
Telephone Number	:	719-251-4006
Fax Number	:

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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