Healthcare Provider Details

I. General information

NPI: 1760567614
Provider Name (Legal Business Name): EMILY STODDARD ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 E 16TH AVE
AURORA CO
80045-2545
US

IV. Provider business mailing address

455 1ST ST
WOODLAND CA
95695-4023
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0000
  • Fax:
Mailing address:
  • Phone: 530-662-2211
  • Fax: 530-662-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW18984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: