Healthcare Provider Details

I. General information

NPI: 1093678013
Provider Name (Legal Business Name): KAYLA CHEATHAM LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MERCURY VILLAGE DR
DURANGO CO
81301-8955
US

IV. Provider business mailing address

205 COUNTY ROAD 224
DURANGO CO
81301-7032
US

V. Phone/Fax

Practice location:
  • Phone: 970-335-2422
  • Fax:
Mailing address:
  • Phone: 901-283-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW.0009927003
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: