Healthcare Provider Details

I. General information

NPI: 1952032831
Provider Name (Legal Business Name): JULIA KENNEDY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 BOURGMONT CT
TIMNATH CO
80547-5829
US

IV. Provider business mailing address

4824 BOURGMONT CT
TIMNATH CO
80547-5829
US

V. Phone/Fax

Practice location:
  • Phone: 970-325-6166
  • Fax:
Mailing address:
  • Phone: 970-325-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0000000825
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09930974
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: