MEDICARE: MS. MARCIA MCCONNELL RANCH L.C.S.W.

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	989175	CO

General Provider Information

NPI Number	:	1851519383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA MCCONNELL RANCH L.C.S.W.

Provider Business Mailing Address
First Line	:	375 E HORSETOOTH RD
Second Line	:	BUILDING 3, SUITE 201
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3155
Country	:	US
Telephone Number	:	970-223-0356
Fax Number	:	970-204-9767

Provider Business Practice Location Address
First Line	:	375 E HORSETOOTH RD
Second Line	:	BUILDING 3, SUITE 201
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3155
Country	:	US
Telephone Number	:	970-223-0356
Fax Number	:	970-204-9767

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

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	07/08/2007

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