MEDICARE: MS. WENDY LISA BIGELSON LCSW,ACSW

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	989347	CO

General Provider Information

NPI Number	:	1548400864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WENDY LISA BIGELSON LCSW,ACSW

Provider Business Mailing Address
First Line	:	2395 HILLSDALE WAY
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80305-5623
Country	:	US
Telephone Number	:	303-499-3505
Fax Number	:

Provider Business Practice Location Address
First Line	:	5277 MANHATTAN CIR
Second Line	:	SUITE 110
City	:	BOULDER
State	:	CO
Zip	:	80303-8201
Country	:	US
Telephone Number	:	303-543-5785
Fax Number	:	303-543-5782

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

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	02/26/2009

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