MEDICARE: MRS. SUSANNA LYNN PRENSNER 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	CSW.09925805	CO

General Provider Information

NPI Number	:	1952635922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSANNA LYNN PRENSNER LCSW

Provider Business Mailing Address
First Line	:	10720 HUNGATE RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-4382
Country	:	US
Telephone Number	:	719-238-1571
Fax Number	:

Provider Business Practice Location Address
First Line	:	10720 HUNGATE RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-4382
Country	:	US
Telephone Number	:	719-238-1571
Fax Number	:

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

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	03/11/2019

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