Healthcare Provider Details

I. General information

NPI: 1700066297
Provider Name (Legal Business Name): SARAH WELLS L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH WELLS FREY L.C.S.W.

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6059 S QUEBEC ST
CENTENNIAL CO
80111-4514
US

IV. Provider business mailing address

6059 S QUEBEC ST
CENTENNIAL CO
80111-4514
US

V. Phone/Fax

Practice location:
  • Phone: 720-261-4983
  • Fax:
Mailing address:
  • Phone: 720-261-4983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number991059
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: