MEDICARE: MR. WILLIAM G SEMPLE MSW

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	989070	CO

General Provider Information

NPI Number	:	1326043183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM G SEMPLE MSW

Provider Business Mailing Address
First Line	:	2030 FLORAL DR
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-2738
Country	:	US
Telephone Number	:	303-449-1669
Fax Number	:	720-306-3263

Provider Business Practice Location Address
First Line	:	2030 FLORAL DR
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-2738
Country	:	US
Telephone Number	:	303-449-1669
Fax Number	:	720-306-3263

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	02/02/2011

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