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NPI Code Detail

MEDICARE: MRS. DEIDRA SUZANNE WARD LCSW, LAC

MEDICARE: MRS. DEIDRA SUZANNE WARD LCSW, LAC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorACB.0007665CO
21041C0700XClinical Social WorkerCSW.09923294CO

General Provider Information

NPI Number : 1659786424
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEIDRA SUZANNE WARD LCSW, LAC
Provider Business Mailing Address
First Line : 1777 S HARRISON ST STE 1200
Second Line :
City : DENVER
State : CO
Zip : 80210-3955
Country : US
Telephone Number : 303-549-8459
Fax Number :
Provider Business Practice Location Address
First Line : 1777 S HARRISON ST STE 1200
Second Line :
City : DENVER
State : CO
Zip : 80210-3955
Country : US
Telephone Number : 303-549-8459
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2014
Last Update Date : 07/31/2019

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