MEDICARE: MRS. THAIS RENEE SHEFFER LCSW

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	070233-1	NY
2	1041C0700X	Clinical Social Worker	CSW-874	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	345402	OTHER		MANAGED HEALTH NETWORK

General Provider Information

NPI Number	:	1578657722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THAIS RENEE SHEFFER LCSW

Provider Business Mailing Address
First Line	:	7755 CONIFER DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4541
Country	:	US
Telephone Number	:	719-534-3717
Fax Number	:

Provider Business Practice Location Address
First Line	:	7755 CONIFER DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-4541
Country	:	US
Telephone Number	:	719-534-3717
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/22/2007

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