MEDICARE: MARILYN NICHOLS WOLFE REV.

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	CSW.9923624	CO

General Provider Information

NPI Number	:	1598173791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN NICHOLS WOLFE REV.

Provider Business Mailing Address
First Line	:	1980 DAHLIA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-1239
Country	:	US
Telephone Number	:	720-445-2187
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 S UNIVERSITY BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4707
Country	:	US
Telephone Number	:	303-639-5249
Fax Number	:

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

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	07/31/2014

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