Provider Demographics
NPI:1023556115
Name:KATHLEEN SALMON, LLC
Entity Type:Organization
Organization Name:KATHLEEN SALMON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SALMON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-400-0311
Mailing Address - Street 1:PO BOX 20261
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-3261
Mailing Address - Country:US
Mailing Address - Phone:908-400-0311
Mailing Address - Fax:
Practice Address - Street 1:1001 E 62ND AVE APT 665
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-1140
Practice Address - Country:US
Practice Address - Phone:908-400-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099245611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty