Healthcare Provider Details

I. General information

NPI: 1801059084
Provider Name (Legal Business Name): SHARI M HARDIES III LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6897 PAIUTE AVE STE 5
NIWOT CO
80503-7169
US

IV. Provider business mailing address

1333 IRIS AVE
BOULDER CO
80304-2226
US

V. Phone/Fax

Practice location:
  • Phone: 303-652-4196
  • Fax: 303-652-4007
Mailing address:
  • Phone: 720-406-3604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1405
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: