Provider Demographics
NPI:1972230167
Name:PHILLIPS, VERONICA ANN (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 HIGHWAY 105
Mailing Address - Street 2:
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133-9003
Mailing Address - Country:US
Mailing Address - Phone:719-884-0063
Mailing Address - Fax:
Practice Address - Street 1:443 HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:PALMER LAKE
Practice Address - State:CO
Practice Address - Zip Code:80133-9003
Practice Address - Country:US
Practice Address - Phone:719-884-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.0000000002104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1922514306Medicaid