MEDICARE: MALISSA TROJAN

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	104100000X	Social Worker	LSW.0009020489	CO
2	1041C0700X	Clinical Social Worker	CSW.09925179	CO
3	1041C0700X	Clinical Social Worker	6801100769	MI
4	1041C0700X	Clinical Social Worker	L8541	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215356381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALISSA TROJAN

Provider Business Mailing Address
First Line	:	27905 MEADOW DR UNIT 11
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-2110
Country	:	US
Telephone Number	:	303-335-9118
Fax Number	:

Provider Business Practice Location Address
First Line	:	27905 MEADOW DR
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-2110
Country	:	US
Telephone Number	:	303-335-9118
Fax Number	:	866-458-0456

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

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	01/01/2026

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Directions to “ MALISSA TROJAN ” Practice Location

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