Healthcare Provider Details

I. General information

NPI: 1710414727
Provider Name (Legal Business Name): AMBER DUGAN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 S PARKER RD STE 102
DENVER CO
80231-7557
US

IV. Provider business mailing address

5200 S ULSTER ST APT 1403
GREENWOOD VILLAGE CO
80111-2865
US

V. Phone/Fax

Practice location:
  • Phone: 720-295-7499
  • Fax:
Mailing address:
  • Phone: 785-817-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number00009923393
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009923393
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: