MEDICARE: COREE WILLIAMS SWC

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	104100000X	Social Worker	.0000000999	CO

General Provider Information

NPI Number	:	1487376000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREE WILLIAMS SWC

Provider Business Mailing Address
First Line	:	8000 E PRENTICE AVE STE B5
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2726
Country	:	US
Telephone Number	:	505-504-0103
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 E PRENTICE AVE STE B5
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2726
Country	:	US
Telephone Number	:	505-504-0103
Fax Number	:

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

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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