Healthcare Provider Details

I. General information

NPI: 1912189952
Provider Name (Legal Business Name): JENNIFER CHOCOLE BIRNIE M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2007
Last Update Date: 12/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BRACKENBURY ST
CRESTED BUTTE CO
81224-9745
US

IV. Provider business mailing address

PO BOX 1558
GUNNISON CO
81230-1558
US

V. Phone/Fax

Practice location:
  • Phone: 970-349-6225
  • Fax:
Mailing address:
  • Phone: 970-349-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: