Healthcare Provider Details

I. General information

NPI: 1063804490
Provider Name (Legal Business Name): LAURA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVENUE CHILDREN'S HOSPITAL COLORADO
AURORA CO
80045
US

IV. Provider business mailing address

2270 S MADISON ST
DENVER CO
80210-4921
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-4715
  • Fax:
Mailing address:
  • Phone: 303-319-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992914
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: