1619318227 NPI number — KATHERINE WALSH FERRELL LSW

Table of content: KATHERINE WALSH FERRELL LSW (NPI 1619318227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619318227 NPI number — KATHERINE WALSH FERRELL LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRELL
Provider First Name:
KATHERINE
Provider Middle Name:
WALSH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLAHERTY
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
WALSH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619318227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3384 CRIPPLE CREEK TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80305-7151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-380-1519
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4455 E 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80220-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-504-6500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0009920024 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)