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General NPI Number Information
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NPI Number | 1609942655
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Entity Type | Individual
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Provider Name | STACEY NELSON MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4371 E 72ND AVE
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City | COMMERCE CITY
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State | CO
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Zip | 80022-1471
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Country | US
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Telephone | 303-853-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 6240 S MONROE DR
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City | CENTENNIAL
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State | CO
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Zip | 80121-3121
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Country | US
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Telephone | 303-740-7784
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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 | 9620083
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License Number State | CO
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