Healthcare Provider Details

I. General information

NPI: 1528391026
Provider Name (Legal Business Name): AMY A WADGINSKI BEHAVIORAL SUPPORT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SAINT PAUL ST STE. 205
DENVER CO
80206-5124
US

IV. Provider business mailing address

300 E 17TH AVE 1027
DENVER CO
80203-1233
US

V. Phone/Fax

Practice location:
  • Phone: 303-333-4062
  • Fax: 303-333-4097
Mailing address:
  • Phone: 619-997-5216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: