MEDICARE: KERRIE C. CARGILL-HITCHCOCK 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	991948	CO

General Provider Information

NPI Number	:	1922075092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRIE C. CARGILL-HITCHCOCK L.C.S.W.

Provider Business Mailing Address
First Line	:	375 NANCY CT
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-3672
Country	:	US
Telephone Number	:	970-203-0957
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 ROBERTSON ST
Second Line	:
City	:	FT COLLINS
State	:	CO
Zip	:	80524-3926
Country	:	US
Telephone Number	:	970-493-6667
Fax Number	:	970-493-8016

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	07/08/2007

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