MEDICARE: MRS. JOHANNA (JODY) H CLEVELAND, LCSW, PLLC 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	1154	CO

General Provider Information

NPI Number	:	1790922102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOHANNA (JODY) H CLEVELAND, LCSW, PLLC LCSW

Provider Business Mailing Address
First Line	:	5350 S ROSLYN ST STE 306
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2124
Country	:	US
Telephone Number	:	303-885-7169
Fax Number	:	303-779-3341

Provider Business Practice Location Address
First Line	:	5350 S ROSLYN ST STE 306
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2124
Country	:	US
Telephone Number	:	303-885-7169
Fax Number	:	303-779-3341

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

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	01/07/2009

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