MEDICARE: MRS. JANE ANN IRVINE M.A., M.A. CANDIDATE

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	101Y00000X	Counselor	9650	CO

General Provider Information

NPI Number	:	1609008978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANE ANN IRVINE M.A., M.A. CANDIDATE

Provider Business Mailing Address
First Line	:	6166 EAST MINERAL PLACE
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-3016
Country	:	US
Telephone Number	:	303-478-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6166 EAST MINERAL PLACE
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-3016
Country	:	US
Telephone Number	:	303-478-4600
Fax Number	:

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

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	08/20/2009

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