MEDICARE: HELENE HOMER-ISHIKAWA 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	1041C0700X	Clinical Social Worker	CSW09924236	CO

General Provider Information

NPI Number	:	1720510530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELENE HOMER-ISHIKAWA LCSW

Provider Business Mailing Address
First Line	:	3939 W 46TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-2646
Country	:	US
Telephone Number	:	201-704-6926
Fax Number	:

Provider Business Practice Location Address
First Line	:	3939 W 46TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-2646
Country	:	US
Telephone Number	:	201-704-6926
Fax Number	:

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

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	03/30/2017

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