MEDICARE: MRS. LOIS JEAN SILLAMAN M.S., L.P.C.

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	101YM0800X	Mental Health Counselor	2610	CO

General Provider Information

NPI Number	:	1659420016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOIS JEAN SILLAMAN M.S., L.P.C.

Provider Business Mailing Address
First Line	:	3130 ELIZABETH AVE
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-9142
Country	:	US
Telephone Number	:	719-275-4409
Fax Number	:	719-275-4409

Provider Business Practice Location Address
First Line	:	3130 ELIZABETH AVE
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-9142
Country	:	US
Telephone Number	:	719-275-4409
Fax Number	:	719-275-4409

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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