Healthcare Provider Details

I. General information

NPI: 1205685930
Provider Name (Legal Business Name): ANNEKE R WARDLAW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 E HORSETOOTH RD BLDG 3101
FORT COLLINS CO
80525-3197
US

IV. Provider business mailing address

375 E HORSETOOTH RD BLDG 3101
FORT COLLINS CO
80525-3197
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax:
Mailing address:
  • Phone: 970-310-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109294
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933091
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: