MEDICARE: MR. DONN ALLEN HANSUM 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	989148	CO

General Provider Information

NPI Number	:	1871898023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONN ALLEN HANSUM LCSW

Provider Business Mailing Address
First Line	:	2582 S DENNISON CT
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-6540
Country	:	US
Telephone Number	:	303-319-8808
Fax Number	:	303-753-9337

Provider Business Practice Location Address
First Line	:	2582 S DENNISON CT
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-6540
Country	:	US
Telephone Number	:	303-319-8808
Fax Number	:	303-753-9337

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

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	01/19/2011

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