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NPI Code Detail

MEDICARE: MR. KENNETH LEE LINGLE LCSW

MEDICARE: MR. KENNETH LEE LINGLE 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
11041C0700XClinical Social Worker992771CO

General Provider Information

NPI Number : 1841313848
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENNETH LEE LINGLE LCSW
Provider Business Mailing Address
First Line : 1342 ADAMS DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80904-1212
Country : US
Telephone Number : 719-290-0488
Fax Number : 719-634-0482
Provider Business Practice Location Address
First Line : 10 FARRAGUT AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-5626
Country : US
Telephone Number : 719-290-0488
Fax Number : 719-634-0482
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2007
Last Update Date : 07/08/2007

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