Healthcare Provider Details

I. General information

NPI: 1386579225
Provider Name (Legal Business Name): LISA WILLARDSON LEISHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 E 104TH AVE STE 302
THORNTON CO
80233-4316
US

IV. Provider business mailing address

2090 E 104TH AVE STE 302
THORNTON CO
80233-4316
US

V. Phone/Fax

Practice location:
  • Phone: 720-798-2226
  • Fax:
Mailing address:
  • Phone: 720-798-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009925985
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: