MEDICARE: MS. JOANNA IOANNIDES MSW/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	103T00000X	Psychologist
2	1041C0700X	Clinical Social Worker	992674	CO

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
2	1114379112	OTHER	CO	GROUP NPI

General Provider Information

NPI Number	:	1285639567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOANNA IOANNIDES MSW/LCSW

Provider Business Mailing Address
First Line	:	6105 S MAIN ST STE 219
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-5361
Country	:	US
Telephone Number	:	720-319-7319
Fax Number	:	303-379-4607

Provider Business Practice Location Address
First Line	:	6105 S MAIN ST STE 219
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-5361
Country	:	US
Telephone Number	:	720-319-7319
Fax Number	:	303-379-4607

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	09/08/2023

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