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General NPI Number Information
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NPI Number | 1104699172
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Entity Type | Individual
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Provider Name | CASSANDRA DETWILER
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Gender | Female
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 10190 BANNOCK ST STE 120
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City | NORTHGLENN
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State | CO
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Zip | 80260-6052
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Country | US
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Telephone | 303-237-6865
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Fax |
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Provider Business Mailing Address
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Address Line | 4716 BLUEGATE DR
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80130-6600
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Country | US
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Telephone | 303-919-8671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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