MEDICARE: CAMERON STULL

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1538795224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON STULL

Provider Business Mailing Address
First Line	:	3311 S ELM ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-7312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 S ELM ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-7312
Country	:	US
Telephone Number	:	303-819-1488
Fax Number	:

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

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	03/13/2020

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Directions to “ CAMERON STULL ” Practice Location

Language	Start Address	Practice Location

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