Healthcare Provider Details

I. General information

NPI: 1477804102
Provider Name (Legal Business Name): KATHERINE SHAW KRIPKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 PINE ST
BOULDER CO
80302-4809
US

IV. Provider business mailing address

2333 MAPLETON AVE
BOULDER CO
80304-3753
US

V. Phone/Fax

Practice location:
  • Phone: 303-586-1564
  • Fax:
Mailing address:
  • Phone: 415-205-6188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1669
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: