MEDICARE: JULIE KAY PATTERSON LCSW

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	989946	CO

General Provider Information

NPI Number	:	1700972189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE KAY PATTERSON LCSW

Provider Business Mailing Address
First Line	:	218 PETERSON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2986
Country	:	US
Telephone Number	:	970-377-3647
Fax Number	:	970-377-9986

Provider Business Practice Location Address
First Line	:	218 PETERSON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-2986
Country	:	US
Telephone Number	:	970-377-3647
Fax Number	:	970-377-9986

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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