MEDICARE: KATHRYN L PRESTON 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	989187	CO

General Provider Information

NPI Number	:	1437344975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN L PRESTON MSW

Provider Business Mailing Address
First Line	:	PO BOX 51237
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80949-1237
Country	:	US
Telephone Number	:	719-593-1608
Fax Number	:

Provider Business Practice Location Address
First Line	:	5140 GOLDEN HILLS CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-8156
Country	:	US
Telephone Number	:	719-321-7905
Fax Number	:

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

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	09/07/2007

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