Healthcare Provider Details

I. General information

NPI: 1326953662
Provider Name (Legal Business Name): EMILY SHANNON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 MAIN ST UNIT 610-12
FRISCO CO
80443-5487
US

IV. Provider business mailing address

522 W 7TH ST
LEADVILLE CO
80461-3830
US

V. Phone/Fax

Practice location:
  • Phone: 720-689-5481
  • Fax:
Mailing address:
  • Phone: 845-803-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0009927547
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: