Healthcare Provider Details

I. General information

NPI: 1154652105
Provider Name (Legal Business Name): EMILY SUSANNE KUNKEL LCSW, MSW,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 EDWARDS ACCESS RD
EDWARDS CO
81632-5634
US

IV. Provider business mailing address

11819 RIDGE PKWY APT 924
BROOMFIELD CO
80021-6500
US

V. Phone/Fax

Practice location:
  • Phone: 970-445-2489
  • Fax:
Mailing address:
  • Phone: 815-440-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: