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NPI Code Detail

MEDICARE: JOANNE K SCANLON MSW

MEDICARE: JOANNE K SCANLON 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
1104100000XSocial Worker991313CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699779306
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNE K SCANLON MSW
Provider Business Mailing Address
First Line : 3450 BROADWAY ST
Second Line :
City : BOULDER
State : CO
Zip : 80304-1824
Country : US
Telephone Number : 303-441-1175
Fax Number : 303-441-1452
Provider Business Practice Location Address
First Line : 3482 BROADWAY ST
Second Line :
City : BOULDER
State : CO
Zip : 80304-1824
Country : US
Telephone Number : 303-413-7500
Fax Number : 303-441-1452
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 07/09/2007

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