MEDICARE: LISA YOUNG-WEBB ED.S.

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	103TS0200X	School Psychologist	222639	CO

General Provider Information

NPI Number	:	1508520784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA YOUNG-WEBB ED.S.

Provider Business Mailing Address
First Line	:	2938 WILD CHERRY LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1489
Country	:	US
Telephone Number	:	719-213-6891
Fax Number	:

Provider Business Practice Location Address
First Line	:	2938 WILD CHERRY LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1489
Country	:	US
Telephone Number	:	719-213-6891
Fax Number	:

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

Provider Enumeration Date	:	10/25/2021
Last Update Date	:	10/25/2021

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