MEDICARE: BROOKE TUTTLE JOSTAD MSW, 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	LCSW-1359	WY
2	1041C0700X	Clinical Social Worker	CSW.09925268	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578939864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE TUTTLE JOSTAD MSW, LCSW

Provider Business Mailing Address
First Line	:	4025 RAWLINS ST
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-1900
Country	:	US
Telephone Number	:	307-426-4797
Fax Number	:	307-426-4799

Provider Business Practice Location Address
First Line	:	2550 STOVER ST BLDG C
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4641
Country	:	US
Telephone Number	:	970-942-3031
Fax Number	:	307-426-4799

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

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	08/01/2023

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