MEDICARE: PAMELA MICHELLE END OF HORN DSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	20122	MN
2	1041C0700X	Clinical Social Worker	CSW.09931488	CO
3	1041C0700X	Clinical Social Worker	3731	ND

General Provider Information

NPI Number	:	1043237043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA MICHELLE END OF HORN DSW

Provider Business Mailing Address
First Line	:	1500 N GRANT ST STE C
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	240-397-3526
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 N GRANT ST STE C
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	240-397-3526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	03/03/2025

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