Healthcare Provider Details

I. General information

NPI: 1588997514
Provider Name (Legal Business Name): GEORGIA SHEPARD ANGELO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 05/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2696 S COLORADO BLVD SUITE 380
DENVER CO
80222-5945
US

IV. Provider business mailing address

2696 S COLORADO BLVD SUITE 380
DENVER CO
80222-5945
US

V. Phone/Fax

Practice location:
  • Phone: 303-639-5240
  • Fax: 303-639-5243
Mailing address:
  • Phone: 303-639-5240
  • Fax: 303-639-5243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09924378
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: