Healthcare Provider Details

I. General information

NPI: 1710070297
Provider Name (Legal Business Name): JANET BYCHEK M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4548 STARBOARD DR
BOULDER CO
80301-3126
US

IV. Provider business mailing address

4548 STARBOARD DR
BOULDER CO
80301-3126
US

V. Phone/Fax

Practice location:
  • Phone: 720-771-6401
  • Fax: 719-452-3488
Mailing address:
  • Phone: 720-771-6401
  • Fax: 719-452-3488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number991035
License Number StateCO

VII. Legacy identifiers

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

# 1
Identifier47503840
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: