MEDICARE: JENNIFER ROUTT

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	NLC.0108959	CO

General Provider Information

NPI Number	:	1326521246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROUTT

Provider Business Mailing Address
First Line	:	803 N WAHSATCH AVE APT 2
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2966
Country	:	US
Telephone Number	:	740-703-1972
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 N WAHSATCH AVE APT 2
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2966
Country	:	US
Telephone Number	:	740-703-1972
Fax Number	:

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

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	09/07/2018

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