Provider Demographics
NPI:1902370091
Name:MUNSTERTEIGER, ELSE (LSW, ADS)
Entity Type:Individual
Prefix:
First Name:ELSE
Middle Name:
Last Name:MUNSTERTEIGER
Suffix:
Gender:F
Credentials:LSW, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 N ELIZABETH ST STE E
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2080
Mailing Address - Country:US
Mailing Address - Phone:719-320-8803
Mailing Address - Fax:
Practice Address - Street 1:4718 N ELIZABETH ST STE E
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2080
Practice Address - Country:US
Practice Address - Phone:719-320-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009922357104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker