MEDICARE: JENNIFER GLACE 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	9924911	CO

General Provider Information

NPI Number	:	1881193068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GLACE LCSW

Provider Business Mailing Address
First Line	:	2910 IOLA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-3199
Country	:	US
Telephone Number	:	570-971-0082
Fax Number	:

Provider Business Practice Location Address
First Line	:	2910 IOLA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-3199
Country	:	US
Telephone Number	:	570-971-0082
Fax Number	:

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

Provider Enumeration Date	:	02/02/2018
Last Update Date	:	02/02/2018

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