Healthcare Provider Details

I. General information

NPI: 1326819400
Provider Name (Legal Business Name): KATHRYN KILLAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9220 TEDDY LN STE 2000
LONE TREE CO
80124-6741
US

IV. Provider business mailing address

13400 WATERTHRUSH ST
PARKER CO
80134-6741
US

V. Phone/Fax

Practice location:
  • Phone: 720-295-7304
  • Fax:
Mailing address:
  • Phone: 303-501-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09928554
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: