=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407536717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SYLVIA C WEBER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2023
-----------------------------------------------------
Last Update Date | 07/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4102 PINION DR
-----------------------------------------------------
City | USAF ACADEMY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80840-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-246-5004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4102 PINION DR
-----------------------------------------------------
City | USAF ACADEMY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80840-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW.09926842
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------