MEDICARE: KATHERINE DUGGLEBY 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	CSW.09925709	CO

General Provider Information

NPI Number	:	1508336942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DUGGLEBY LCSW

Provider Business Mailing Address
First Line	:	875 W MORENO AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-1731
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 W RIO GRANDE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4013
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:

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

Provider Enumeration Date	:	11/28/2018
Last Update Date	:	03/30/2020

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