MEDICARE: AMANDA DODSON LCSW LLC

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

General Provider Information

NPI Number	:	1548041023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANDA DODSON LCSW LLC

Provider Business Mailing Address
First Line	:	2390 HUDSON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3260
Country	:	US
Telephone Number	:	720-772-1266
Fax Number	:

Provider Business Practice Location Address
First Line	:	2390 HUDSON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80207-3260
Country	:	US
Telephone Number	:	720-772-1266
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT OF LLC
Name	:	AMANDA DODSON
Credential	:	LCSW
Telephone Number	:	720-772-1266

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	10/10/2023

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