Healthcare Provider Details

I. General information

NPI: 1053254631
Provider Name (Legal Business Name): LAUREL N BIDWELL MSW, PHD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2269 PALM DR
COLORADO SPRINGS CO
80918-7813
US

IV. Provider business mailing address

2269 PALM DR
COLORADO SPRINGS CO
80918-7813
US

V. Phone/Fax

Practice location:
  • Phone: 651-925-6040
  • Fax:
Mailing address:
  • Phone: 651-925-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09929619
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: