MEDICARE: DR. GALE J TERRY PH.D.

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	989207	CO

General Provider Information

NPI Number	:	1518086594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GALE J TERRY PH.D.

Provider Business Mailing Address
First Line	:	360 S MONROE ST
Second Line	:	SUITE 155
City	:	DENVER
State	:	CO
Zip	:	80209-3705
Country	:	US
Telephone Number	:	303-399-3770
Fax Number	:	303-321-6917

Provider Business Practice Location Address
First Line	:	360 S MONROE ST
Second Line	:	SUITE 155
City	:	DENVER
State	:	CO
Zip	:	80209-3705
Country	:	US
Telephone Number	:	303-399-3770
Fax Number	:	303-321-6917

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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