MEDICARE: KIRSTEN ANDERSON M.S.W.

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	CSW.00992735	CO

General Provider Information

NPI Number	:	1477960011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN ANDERSON M.S.W.

Provider Business Mailing Address
First Line	:	3003 EDISON CT
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-2246
Country	:	US
Telephone Number	:	303-883-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 EDISON CT
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-2246
Country	:	US
Telephone Number	:	303-883-9123
Fax Number	:

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

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	07/15/2014

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