MEDICARE: ROGER M. REYNOLDS LCSW & ASSOCIATES

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

General Provider Information

NPI Number	:	1912473539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROGER M. REYNOLDS LCSW & ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 881275
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80488-1275
Country	:	US
Telephone Number	:	970-879-5520
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 PINE GROVE RD STE 206
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8851
Country	:	US
Telephone Number	:	970-879-5520
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROGER M REYNOLDS
Credential	:
Telephone Number	:	970-879-5520

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	10/22/2018

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