MEDICARE: SHANNON KATHRYN KLINE-GLINSKI

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	CSW.09930151	CO
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1407310816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON KATHRYN KLINE-GLINSKI

Provider Business Mailing Address
First Line	:	715 HORIZON DR STE 225
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 SOUTH LINCOLN AVE
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8934
Country	:	US
Telephone Number	:	970-879-2141
Fax Number	:	970-879-7912

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

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	02/13/2024

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