MEDICARE: LISA CASPERSON

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	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker	9930224	CO

General Provider Information

NPI Number	:	1801321047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA CASPERSON

Provider Business Mailing Address
First Line	:	155 S MADISON ST STE 306
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-3014
Country	:	US
Telephone Number	:	970-576-1717
Fax Number	:	208-567-5844

Provider Business Practice Location Address
First Line	:	2850 MCCLELLAND DR STE 3400
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2572
Country	:	US
Telephone Number	:	866-285-2929
Fax Number	:	208-567-5844

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

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	07/18/2024

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