Healthcare Provider Details

I. General information

NPI: 1316802499
Provider Name (Legal Business Name): EMMA SICKLES RDN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7190 COLORADO BLVD STE 200
COMMERCE CITY CO
80022-1804
US

IV. Provider business mailing address

7190 COLORADO BLVD STE 200
COMMERCE CITY CO
80022-1804
US

V. Phone/Fax

Practice location:
  • Phone: 303-325-3540
  • Fax:
Mailing address:
  • Phone: 303-325-3540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86100386
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number325720
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: