MEDICARE: MARY SUSAN KNUTSON MSP

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1588286181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SUSAN KNUTSON MSP

Provider Business Mailing Address
First Line	:	1001 GRAND AVE UNIT 5
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3642
Country	:	US
Telephone Number	:	970-924-0484
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 GRAND AVE UNIT 5
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3642
Country	:	US
Telephone Number	:	970-924-0484
Fax Number	:

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

Provider Enumeration Date	:	05/18/2020
Last Update Date	:	05/18/2020

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