MEDICARE: JO FREDERIC LCSW INC

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

General Provider Information

NPI Number	:	1851676233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JO FREDERIC LCSW INC

Provider Business Mailing Address
First Line	:	132 SILVER FOX CT
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80121-2123
Country	:	US
Telephone Number	:	303-721-8999
Fax Number	:	303-221-5453

Provider Business Practice Location Address
First Line	:	132 SILVER FOX CT
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80121-2123
Country	:	US
Telephone Number	:	303-721-8999
Fax Number	:	303-221-5453

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LINDA JO FREDERIC
Credential	:	ACSW LCSW CSWG
Telephone Number	:	303-721-8999

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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