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NPI Code Detail

MEDICARE: KATHLEEN ST. JOHN MM, MT-BC, NMT

MEDICARE: KATHLEEN ST. JOHN MM, MT-BC, NMT
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
1225A00000XMusic Therapist06784CO

General Provider Information

NPI Number : 1508196635
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN ST. JOHN MM, MT-BC, NMT
Provider Business Mailing Address
First Line : 510 NORMAN DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80911-1831
Country : US
Telephone Number : 719-213-4330
Fax Number : 719-352-3678
Provider Business Practice Location Address
First Line : 830 TENDERFOOT HILL RD
Second Line : SUITE 150
City : COLORADO SPRINGS
State : CO
Zip : 80906-2314
Country : US
Telephone Number : 719-213-4330
Fax Number : 719-352-3678
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2010
Last Update Date : 02/07/2013

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