MEDICARE: AMY A. MANN

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

General Provider Information

NPI Number	:	1922735711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY A. MANN

Provider Business Mailing Address
First Line	:	4705 E LOUISIANA AVE # A-111
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80246-3435
Country	:	US
Telephone Number	:	419-261-0944
Fax Number	:

Provider Business Practice Location Address
First Line	:	4705 E LOUISIANA AVE # A-111
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80246-3435
Country	:	US
Telephone Number	:	419-261-0944
Fax Number	:

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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