Healthcare Provider Details

I. General information

NPI: 1275264657
Provider Name (Legal Business Name): MRS. NICOLE LEANNE MENDIGOCHEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5554 S PRINCE ST
LITTLETON CO
80120-1149
US

IV. Provider business mailing address

116 INVERNESS DR E STE 105
ENGLEWOOD CO
80112-5125
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-8858
  • Fax:
Mailing address:
  • Phone: 303-730-8858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933488
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: