MEDICARE: SUSAN STILLMAN

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	992985	CO

General Provider Information

NPI Number	:	1154304061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN STILLMAN

Provider Business Mailing Address
First Line	:	6638 W OTTAWA AVE
Second Line	:	SUITE 140-2
City	:	LITTLETON
State	:	CO
Zip	:	80128-4562
Country	:	US
Telephone Number	:	303-972-6202
Fax Number	:	303-972-6215

Provider Business Practice Location Address
First Line	:	6638 W OTTAWA AVE
Second Line	:	SUITE 140-2
City	:	LITTLETON
State	:	CO
Zip	:	80128-4562
Country	:	US
Telephone Number	:	303-972-6202
Fax Number	:	303-972-6215

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	07/29/2009

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Directions to “ SUSAN STILLMAN ” Practice Location

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