MEDICARE: KATHRYN ELIZABETH COLE DISALLE LCSW

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1902219173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ELIZABETH COLE DISALLE LCSW

Provider Business Mailing Address
First Line	:	1333 IRIS AVE
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-2226
Country	:	US
Telephone Number	:	419-376-6960
Fax Number	:

Provider Business Practice Location Address
First Line	:	2560 SHERIDAN BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80214-3011
Country	:	US
Telephone Number	:	720-515-3681
Fax Number	:

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

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	05/19/2025

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