=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760710818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SSUSAN ELIZABETH HORN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2009
-----------------------------------------------------
Last Update Date | 12/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 27TH ST SUITE 145
-----------------------------------------------------
City | GLENWOOD SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81601-4194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-947-9497
-----------------------------------------------------
Fax | 907-947-9497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 27TH ST SUITE 145
-----------------------------------------------------
City | GLENWOOD SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81601-4194
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-947-9497
-----------------------------------------------------
Fax | 907-947-9497
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | MS. SUSAN ELIZABETH HORN
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 970-947-9497
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 991367
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------