Healthcare Provider Details

I. General information

NPI: 1548189848
Provider Name (Legal Business Name): TERESA ROUSE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9559 ELIZABETH CT
THORNTON CO
80229-3914
US

IV. Provider business mailing address

9559 ELIZABETH CT
THORNTON CO
80229-3914
US

V. Phone/Fax

Practice location:
  • Phone: 720-278-5090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009926741
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: