MEDICARE: MS. BARBARA ANN WISOTT L.C.S.W.

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	594	CO

General Provider Information

NPI Number	:	1639196462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA ANN WISOTT L.C.S.W.

Provider Business Mailing Address
First Line	:	155 VAN GORDON ST
Second Line	:	SUITE 395
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1709
Country	:	US
Telephone Number	:	303-914-2688
Fax Number	:	303-914-2682

Provider Business Practice Location Address
First Line	:	155 VAN GORDON ST
Second Line	:	SUITE 395
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1709
Country	:	US
Telephone Number	:	303-914-2688
Fax Number	:	303-914-2682

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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