Healthcare Provider Details

I. General information

NPI: 1063341287
Provider Name (Legal Business Name): KATIE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2342 N BROADWAY
DENVER CO
80205-2178
US

IV. Provider business mailing address

1614 E 24TH AVE
DENVER CO
80205-5349
US

V. Phone/Fax

Practice location:
  • Phone: 707-490-2101
  • Fax:
Mailing address:
  • Phone: 707-490-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW09931011
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: