MEDICARE: JENNIFER MARIE SILVA LCSW, LAC

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	ACD.0001781	CO
2	1041C0700X	Clinical Social Worker	LSW.0009922734	CO
3	1041C0700X	Clinical Social Worker	CSW.09927746	CO

General Provider Information

NPI Number	:	1477146181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE SILVA LCSW, LAC

Provider Business Mailing Address
First Line	:	551 PEYTON DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-8263
Country	:	US
Telephone Number	:	303-345-8004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 MCCLELLAND DR STE 3400
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2572
Country	:	US
Telephone Number	:	303-345-8004
Fax Number	:

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

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	10/26/2023

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