MEDICARE: JODI OBIREK 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	09924605	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881969574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI OBIREK LCSW

Provider Business Mailing Address
First Line	:	1625 S MURRAY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-4502
Country	:	US
Telephone Number	:	719-884-2353
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 S MURRAY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-4502
Country	:	US
Telephone Number	:	719-884-2353
Fax Number	:

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

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	10/04/2021

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