Healthcare Provider Details

I. General information

NPI: 1548512395
Provider Name (Legal Business Name): TANYA ROE SCHIMON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANYA ROE SCHIMON-BAKER L.C.S.W.

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 WETZEL AVE BUILDING 1526
COLORADO SPRINGS CO
80913-4188
US

IV. Provider business mailing address

6303 WETZEL AVE BUILDING 1526
COLORADO SPRINGS CO
80913-4188
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-1577
  • Fax:
Mailing address:
  • Phone: 719-526-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number774
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1840
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: