Physician Compare National (NPI:1982252698)

HEALTHCARE PROVIDER: AMIESSA DAWN JUTTEN LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1982252698
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0547592974
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20191104002050
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JUTTEN
	Individual professional last name
Provider First Name	AMIESSA
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1010 S CASCADE AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE E
	Group Practice or individual's line 2 address
City	MONTROSE
	Group Practice or individual's city
State	CO
	Group Practice or individual's state
Zip Code	814014980
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y