MEDICARE: JESSICA CURRY LCSW, LAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0001812	CO
2	104100000X	Social Worker	LSW.0009921367	CO
3	1041C0700X	Clinical Social Worker	CSW.09925585	CO

General Provider Information

NPI Number	:	1619413739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CURRY LCSW, LAC

Provider Business Mailing Address
First Line	:	1301 S 8TH ST
Second Line	:	STE. 200
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7335
Country	:	US
Telephone Number	:	719-578-9092
Fax Number	:	719-578-8690

Provider Business Practice Location Address
First Line	:	1301 S 8TH ST
Second Line	:	STE. 200
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7335
Country	:	US
Telephone Number	:	719-578-9092
Fax Number	:	719-578-8690

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

Provider Enumeration Date	:	01/12/2017
Last Update Date	:	04/20/2022

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