MEDICARE: TERESA KLAVOHN

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1689798688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA KLAVOHN

Provider Business Mailing Address
First Line	:	1233 OGDEN ST APT 106
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3940 S NARCISSUS WAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-2024
Country	:	US
Telephone Number	:	303-639-9728
Fax Number	:

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

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	07/08/2007

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