MEDICARE: TAWNIA VALDEZ 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	CSW09926916	CO

General Provider Information

NPI Number	:	1922464916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWNIA VALDEZ LCSW

Provider Business Mailing Address
First Line	:	PO BOX 6562
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80934-6562
Country	:	US
Telephone Number	:	719-565-7868
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 N TEJON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4926
Country	:	US
Telephone Number	:	719-401-3035
Fax Number	:

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

Provider Enumeration Date	:	01/07/2016
Last Update Date	:	05/19/2021

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