Healthcare Provider Details

I. General information

NPI: 1063990174
Provider Name (Legal Business Name): THERESA GRZESLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 10/16/2023
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S CHERRY ST STE 1675
DENVER CO
80246-2532
US

IV. Provider business mailing address

950 S CHERRY ST STE 1675
DENVER CO
80246-2532
US

V. Phone/Fax

Practice location:
  • Phone: 720-443-3114
  • Fax:
Mailing address:
  • Phone: 720-443-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09926472
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: