Basic Information
Provider Information
NPI: 1639576515
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASH
FirstName: DELORES
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 421 ZANG ST
Address2:  
City: LAKEWOOD
State: CO
PostalCode: 802281052
CountryCode: US
TelephoneNumber: 3039894357
FaxNumber: 3039882017
Practice Location
Address1: 421 ZANG ST
Address2:  
City: LAKEWOOD
State: CO
PostalCode: 802281052
CountryCode: US
TelephoneNumber: 3039894357
FaxNumber: 3039882017
Other Information
ProviderEnumerationDate: 11/20/2014
LastUpdateDate: 11/20/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XSWP-LCSW-LIC-8430MTY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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