MEDICARE: SALLY MARGARITA BLEIER 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	50148	TX
2	1041C0700X	Clinical Social Worker	CSW.09924648	CO

General Provider Information

NPI Number	:	1417061649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY MARGARITA BLEIER LCSW

Provider Business Mailing Address
First Line	:	3205 N ACADEMY BLVD STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5152
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4863 N NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3951
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	03/17/2018

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