MEDICARE: MRS. HANNAH BLAIR MARTIN SWC

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	171400000X	Health & Wellness Coach
2	171M00000X	Case Manager/Care Coordinator
3	1041C0700X	Clinical Social Worker	SWC.0000002440	CO

General Provider Information

NPI Number	:	1659907368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HANNAH BLAIR MARTIN SWC

Provider Business Mailing Address
First Line	:	2550 STOVER ST BLDG C
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4641
Country	:	US
Telephone Number	:	970-942-3031
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 STOVER ST BLDG C
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4641
Country	:	US
Telephone Number	:	970-942-3031
Fax Number	:

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

Provider Enumeration Date	:	03/14/2020
Last Update Date	:	04/15/2025

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