MEDICARE: DANIELLE HENDRIX

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1508694027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE HENDRIX

Provider Business Mailing Address
First Line	:	1816 WOOD AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7357
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 W FOUNTAIN BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4132
Country	:	US
Telephone Number	:	719-426-8200
Fax Number	:

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

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	07/25/2024

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Directions to “ DANIELLE HENDRIX ” Practice Location

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