Provider Demographics
NPI:1568677680
Name:WIENS, KAREN S (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:WIENS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:WIENS
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2411 N TEJON
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-632-6202
Mailing Address - Fax:719-481-3708
Practice Address - Street 1:2411 N TEJON
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907
Practice Address - Country:US
Practice Address - Phone:719-632-6202
Practice Address - Fax:719-481-3708
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9861191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
87216Medicare ID - Type Unspecified