MEDICARE: EMILY ANDERSON-DIEPENBROCK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW.09932188	CO

General Provider Information

NPI Number	:	1174400105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANDERSON-DIEPENBROCK LCSW

Provider Business Mailing Address
First Line	:	2010 UPLAND AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-0936
Country	:	US
Telephone Number	:	360-201-5896
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 CENTENNIAL PKWY STE 220
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-1619
Country	:	US
Telephone Number	:	360-201-5896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2025
Last Update Date	:	08/20/2025

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