Healthcare Provider Details

I. General information

NPI: 1023390432
Provider Name (Legal Business Name): KEN WINN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 N WILLIAMS ST APT 901
DENVER CO
80218-2672
US

IV. Provider business mailing address

1313 N WILLIAMS ST APT 901
DENVER CO
80218-2672
US

V. Phone/Fax

Practice location:
  • Phone: 813-215-7236
  • Fax: 720-368-4580
Mailing address:
  • Phone: 813-215-7236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-08-4581
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: