Healthcare Provider Details

I. General information

NPI: 1821820549
Provider Name (Legal Business Name): FEET FORWARD - PEER SERVICES AND OUTREACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 CANYON BLVD
BOULDER CO
80302
US

IV. Provider business mailing address

1043 E 20TH AVE
DENVER CO
80205-5201
US

V. Phone/Fax

Practice location:
  • Phone: 720-520-2097
  • Fax:
Mailing address:
  • Phone: 720-840-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. MARY A. PUTMAN
Title or Position: ORGANIZATIONAL CONSTULTANT
Credential:
Phone: 720-840-2443