Basic Information
| Provider Information | |||||||||
| NPI: | 1912521238 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STADELE | ||||||||
| FirstName: | EMMA | ||||||||
| MiddleName: | KATHERINE | ||||||||
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| Credential: | STUDENT CLINICIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7806 W 90TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800214502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038087501 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2450 S VINE ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802105264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038713736 | ||||||||
| FaxNumber: | 3038717656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2020 | ||||||||
| LastUpdateDate: | 06/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.