MEDICARE: JESSICA ANN TROUTWINE

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	106S00000X	Behavior Technician	RBT-18-70751	CO

General Provider Information

NPI Number	:	1457900078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANN TROUTWINE

Provider Business Mailing Address
First Line	:	4905 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4063
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4905 N UNION BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4063
Country	:	US
Telephone Number	:	717-344-8756
Fax Number	:

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

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	09/06/2019

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Directions to “ JESSICA ANN TROUTWINE ” Practice Location

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