MEDICARE: NATALIE WILDER DEVILLE MSW, LSW

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	47	CO

General Provider Information

NPI Number	:	1316198021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE WILDER DEVILLE MSW, LSW

Provider Business Mailing Address
First Line	:	14360 ERIN CT
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80023-9579
Country	:	US
Telephone Number	:	720-252-5265
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 S HARLAN ST STE 200
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-3552
Country	:	US
Telephone Number	:	303-922-3433
Fax Number	:	303-922-7335

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

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	06/11/2019

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