Provider Demographics
NPI:1407964836
Name:SCHOONOVER, KAYE DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:DIANE
Last Name:SCHOONOVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 N UNION BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2045
Mailing Address - Country:US
Mailing Address - Phone:719-266-1891
Mailing Address - Fax:719-266-1934
Practice Address - Street 1:5170 N UNION BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2045
Practice Address - Country:US
Practice Address - Phone:719-266-1891
Practice Address - Fax:719-266-1934
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9898821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO035660Medicaid