Basic Information
| Provider Information | |||||||||
| NPI: | 1063780054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODARD | ||||||||
| FirstName: | KELLI | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3266 JASMINE ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802072117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033203790 | ||||||||
| FaxNumber: | 3033204290 | ||||||||
| Practice Location | |||||||||
| Address1: | 3201 S TAMARAC DR | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802314360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202484701 | ||||||||
| FaxNumber: | 3035977700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2011 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW-1970 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.