Healthcare Provider Details

I. General information

NPI: 1417005091
Provider Name (Legal Business Name): KELLY LYNN CAYWOOD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE B130
AURORA CO
80045-7106
US

IV. Provider business mailing address

13123 E 16TH AVE B130
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-8379
  • Fax: 720-777-7309
Mailing address:
  • Phone: 720-777-8379
  • Fax: 720-777-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3279
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: