Healthcare Provider Details

I. General information

NPI: 1912276312
Provider Name (Legal Business Name): KATE ELLARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATE HARDING LCSW

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 08/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 IDYLWILD TRL
BOULDER CO
80301
US

IV. Provider business mailing address

5412 IDYLWILD TRL
BOULDER CO
80301-3523
US

V. Phone/Fax

Practice location:
  • Phone: 720-310-5125
  • Fax:
Mailing address:
  • Phone: 720-310-5125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992554
License Number StateCO

VII. Legacy identifiers

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

# 1
Identifier992554
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerLCSW

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: