MEDICARE: AMY RUESCHE 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	LSW.0009922767	CO
2	1041C0700X	Clinical Social Worker	09928163	CO

General Provider Information

NPI Number	:	1629651328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY RUESCHE LCSW

Provider Business Mailing Address
First Line	:	4297 AUSTIN BLUFFS PKWY STE 103
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2951
Country	:	US
Telephone Number	:	719-286-0283
Fax Number	:

Provider Business Practice Location Address
First Line	:	4297 AUSTIN BLUFFS PKWY STE 103
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2951
Country	:	US
Telephone Number	:	719-286-0283
Fax Number	:

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

Provider Enumeration Date	:	04/30/2021
Last Update Date	:	04/04/2022

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