MEDICARE: KRISTI L MEYER LCSW, ADS

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	2220	SD
2	1041C0700X	Clinical Social Worker	CSW.09923601	CO

General Provider Information

NPI Number	:	1275718215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI L MEYER LCSW, ADS

Provider Business Mailing Address
First Line	:	1231 BALDWIN AVE
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-4927
Country	:	US
Telephone Number	:	605-390-3744
Fax Number	:	719-452-3752

Provider Business Practice Location Address
First Line	:	1231 BALDWIN AVE
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-4927
Country	:	US
Telephone Number	:	605-390-3744
Fax Number	:	719-452-3752

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

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	11/09/2016

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