Healthcare Provider Details

I. General information

NPI: 1669381778
Provider Name (Legal Business Name): OLIVIA S PENOYER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 122ND AVE STE 140
WESTMINSTER CO
80234-3440
US

IV. Provider business mailing address

1130 S UNIVERSITY BLVD
DENVER CO
80210-1907
US

V. Phone/Fax

Practice location:
  • Phone: 315-679-0939
  • Fax:
Mailing address:
  • Phone: 315-679-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0009926562
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: