Healthcare Provider Details

I. General information

NPI: 1588864029
Provider Name (Legal Business Name): KRISTIE MICHELLE LADEGARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK STREET
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-7777
  • Fax:
Mailing address:
  • Phone: 720-417-8976
  • Fax: 303-602-9610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number45894
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number45894
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: