MEDICARE: PHYLLIS SUSAN CLARK MSW

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	CSW.00000022	CO

General Provider Information

NPI Number	:	1679539076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS SUSAN CLARK MSW

Provider Business Mailing Address
First Line	:	PO BOX 771636
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80477-1636
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 LINCOLN AVE STE 200
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-4972
Country	:	US
Telephone Number	:	970-819-2752
Fax Number	:

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	04/23/2026

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