Healthcare Provider Details

I. General information

NPI: 1811443625
Provider Name (Legal Business Name): SHANNON REBECCA LAMB LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EAST SIMPSON STREET SUITE 210
LAFAYETTE CO
80026
US

IV. Provider business mailing address

400 EAST SIMPSON STREET SUITE 210
LAFAYETTE CO
80026
US

V. Phone/Fax

Practice location:
  • Phone: 720-443-1826
  • Fax:
Mailing address:
  • Phone: 720-443-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925948
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: