Healthcare Provider Details

I. General information

NPI: 1760209589
Provider Name (Legal Business Name): AMELIE J GALLEGOS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SPECHT POINT RD # 130
FORT COLLINS CO
80525-4311
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-5891
  • Fax: 970-494-5895
Mailing address:
  • Phone: 419-695-8010
  • Fax: 419-695-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933655
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009925554
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: