Healthcare Provider Details

I. General information

NPI: 1366471799
Provider Name (Legal Business Name): AILEEN CALLAHAN BURRELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AILEEN LYNN CALLAHAN LCSW

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 W FORT ST. FL 2
BOISE ID
83702-4535
US

IV. Provider business mailing address

8000 E PRENTICE AVE B-13
GREENWOOD VILLAGE CO
80111-2744
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1018
  • Fax:
Mailing address:
  • Phone: 720-339-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number992929
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: