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NPI Code Detail

MEDICARE: EMILIA BROADHURST EALOM LCSW

MEDICARE: EMILIA BROADHURST EALOM 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
11041C0700XClinical Social WorkerCSW.09923634CO

General Provider Information

NPI Number : 1588063978
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILIA BROADHURST EALOM LCSW
Provider Business Mailing Address
First Line : 4891 INDEPENDENCE ST STE 165
Second Line :
City : WHEAT RIDGE
State : CO
Zip : 80033-6714
Country : US
Telephone Number : 303-456-0600
Fax Number :
Provider Business Practice Location Address
First Line : 4891 INDEPENDENCE ST STE 165
Second Line :
City : WHEAT RIDGE
State : CO
Zip : 80033-6714
Country : US
Telephone Number : 303-456-0600
Fax Number : 303-456-0607
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2014
Last Update Date : 02/06/2026

Similar Medicare Providers

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Directions to “ EMILIA BROADHURST EALOM LCSW” Practice Location

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