MEDICARE: SANTINA APRIL WAHL

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.09932924	CO

General Provider Information

NPI Number	:	1619481140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTINA APRIL WAHL

Provider Business Mailing Address
First Line	:	215 6TH AVE
Second Line	:	BOX 215
City	:	WINDSOR
State	:	CO
Zip	:	80550
Country	:	US
Telephone Number	:	808-358-0399
Fax Number	:	715-569-8752

Provider Business Practice Location Address
First Line	:	3000 S COLLEGE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2558
Country	:	US
Telephone Number	:	970-472-1207
Fax Number	:	970-493-1305

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

Provider Enumeration Date	:	11/20/2017
Last Update Date	:	04/08/2026

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