MEDICARE: PAYGE WYMAN LSW, BCABA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	0-21-13112	CO
2	104100000X	Social Worker	LSW.0009926693	CO

General Provider Information

NPI Number	:	1215445176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYGE WYMAN LSW, BCABA

Provider Business Mailing Address
First Line	:	1075 E SOUTH BOULDER RD STE 225
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-2562
Country	:	US
Telephone Number	:	303-554-5609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 E SOUTH BOULDER RD STE 225
Second Line	:
City	:	LOUISVILLE
State	:	CO
Zip	:	80027-2562
Country	:	US
Telephone Number	:	303-554-5609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2018
Last Update Date	:	01/23/2026

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