MEDICARE: MS. AMANDA SUE WATKINS LCSW

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	CSW.09926369	CO

General Provider Information

NPI Number	:	1275179442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA SUE WATKINS LCSW

Provider Business Mailing Address
First Line	:	7665 ASSISI HTS
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3837
Country	:	US
Telephone Number	:	719-955-7008
Fax Number	:	719-598-0346

Provider Business Practice Location Address
First Line	:	7665 ASSISI HTS
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3837
Country	:	US
Telephone Number	:	719-955-7008
Fax Number	:	719-598-0346

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

Provider Enumeration Date	:	11/22/2019
Last Update Date	:	11/22/2019

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