Healthcare Provider Details

I. General information

NPI: 1578478533
Provider Name (Legal Business Name): DAISY RUBY LESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3472 RESEARCH PKWY STE 104-8295
COLORADO SPRINGS CO
80920-1066
US

IV. Provider business mailing address

3472 RESEARCH PKWY STE 104-8295
COLORADO SPRINGS CO
80920-1066
US

V. Phone/Fax

Practice location:
  • Phone: 719-334-2869
  • Fax:
Mailing address:
  • Phone: 719-334-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933586
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: