MEDICARE: KRISTEN E. HAFLETT 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	104100000X	Social Worker	SW126691	PA
2	1041C0700X	Clinical Social Worker	CW016762	PA
3	1041C0700X	Clinical Social Worker	1837	CO

General Provider Information

NPI Number	:	1598906281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN E. HAFLETT LCSW

Provider Business Mailing Address
First Line	:	624 E JEFFERSON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7026
Country	:	US
Telephone Number	:	412-337-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	5855 LEHMAN DR STE 202
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3492
Country	:	US
Telephone Number	:	719-377-5335
Fax Number	:	719-377-5929

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

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	07/27/2020

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