Healthcare Provider Details

I. General information

NPI: 1689322984
Provider Name (Legal Business Name): REBECCA LEIGH CALDWELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 S SYRACUSE WAY STE 260
GREENWOOD VILLAGE CO
80111-4739
US

IV. Provider business mailing address

PO BOX 100361
DENVER CO
80250-0361
US

V. Phone/Fax

Practice location:
  • Phone: 720-339-4714
  • Fax:
Mailing address:
  • Phone: 720-339-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0002775
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: