Provider Demographics
NPI:1790593465
Name:VILLANO, ANNE JENSEN (LSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:JENSEN
Last Name:VILLANO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:ELIZABETH
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16408 BLUE YONDER VW
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7806
Mailing Address - Country:US
Mailing Address - Phone:518-353-3822
Mailing Address - Fax:
Practice Address - Street 1:6430 BROOK PARK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1432
Practice Address - Country:US
Practice Address - Phone:855-222-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2293041041C0700X
COLSW.0009925783104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical