MEDICARE: KENNETH R MONTOUR LCSW, LICSW

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	LW60336220	WA
2	1041C0700X	Clinical Social Worker	CSW.09924681	CO

General Provider Information

NPI Number	:	1447765011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH R MONTOUR LCSW, LICSW

Provider Business Mailing Address
First Line	:	5030 SQUIRRELTAIL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 SQUIRRELTAIL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7635
Country	:	US
Telephone Number	:	720-323-3684
Fax Number	:

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

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	12/05/2017

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