Healthcare Provider Details

I. General information

NPI: 1336700145
Provider Name (Legal Business Name): LAURA DUVALL FERGUSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2019
Last Update Date: 06/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6949 HIGHWAY 73 STE MW-3
EVERGREEN CO
80439-6295
US

IV. Provider business mailing address

9380 S WATSON GULCH RD
LITTLETON CO
80127-9438
US

V. Phone/Fax

Practice location:
  • Phone: 720-318-1373
  • Fax:
Mailing address:
  • Phone: 720-318-1373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09925801
License Number StateCO

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: