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General NPI Number Information
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NPI Number | 1962390484
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Entity Type | Individual
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Provider Name | AUDREY WILSON LSW
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Gender | Female
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 2442 S DOWNING ST STE 250
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City | DENVER
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State | CO
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Zip | 80210-5858
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Country | US
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Telephone | 720-727-7804
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Fax |
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Provider Business Mailing Address
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Address Line | 4717 SPINE RD APT C
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City | BOULDER
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State | CO
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Zip | 80301-5341
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CO
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