Healthcare Provider Details

I. General information

NPI: 1134378102
Provider Name (Legal Business Name): JACQUELYN AAMODT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 ALBION ST
DENVER CO
80220-1028
US

IV. Provider business mailing address

1501 ALBION ST
DENVER CO
80220-1028
US

V. Phone/Fax

Practice location:
  • Phone: 720-881-3409
  • Fax: 303-399-9846
Mailing address:
  • Phone: 720-881-3409
  • Fax: 303-399-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-1144
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: