Healthcare Provider Details

I. General information

NPI: 1932708104
Provider Name (Legal Business Name): EMILY MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 BLAKE ST
DENVER CO
80205-2406
US

IV. Provider business mailing address

3425 BLAKE ST
DENVER CO
80205-2406
US

V. Phone/Fax

Practice location:
  • Phone: 720-744-2755
  • Fax:
Mailing address:
  • Phone: 720-744-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-140723
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: