Healthcare Provider Details

I. General information

NPI: 1497659551
Provider Name (Legal Business Name): ALEXA WILSON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4833 FRONT ST. STE B #600
CASTLE ROCK CO
80104-7901
US

IV. Provider business mailing address

4833 FRONT ST STE B
CASTLE ROCK CO
80104-7901
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-7017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009924315
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: