MEDICARE: FREDLYN NANCY ZITTER-SMITH M.S.W, 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	979010	CO

General Provider Information

NPI Number	:	1760530950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDLYN NANCY ZITTER-SMITH M.S.W, LCSW

Provider Business Mailing Address
First Line	:	2043 PEARL STREET
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302
Country	:	US
Telephone Number	:	303-443-9008
Fax Number	:	303-443-2051

Provider Business Practice Location Address
First Line	:	2043 PEARL ST
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-4429
Country	:	US
Telephone Number	:	303-443-9008
Fax Number	:	303-443-2051

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

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	07/08/2007

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