MEDICARE: ANGELA CONDIT 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	09923859	CO

General Provider Information

NPI Number	:	1477946572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA CONDIT LCSW

Provider Business Mailing Address
First Line	:	PO BOX 20092
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82003-7002
Country	:	US
Telephone Number	:	970-888-4070
Fax Number	:	970-372-6412

Provider Business Practice Location Address
First Line	:	7950 6TH ST
Second Line	:
City	:	WELLINGTON
State	:	CO
Zip	:	80549-1830
Country	:	US
Telephone Number	:	970-888-4070
Fax Number	:

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

Provider Enumeration Date	:	03/13/2015
Last Update Date	:	03/19/2020

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Directions to “ ANGELA CONDIT LCSW” Practice Location

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