MEDICARE: MS. CHERIE LOU DRAXTON LCSW

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	991694	CO

General Provider Information

NPI Number	:	1437352754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERIE LOU DRAXTON LCSW

Provider Business Mailing Address
First Line	:	1985 MOUNTAIN ROAD
Second Line	:
City	:	CHIPITA PARK
State	:	CO
Zip	:	80809
Country	:	US
Telephone Number	:	719-684-2281
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E BOULDER
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-8623
Country	:	US
Telephone Number	:	719-365-5297
Fax Number	:	719-365-5569

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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