Provider Demographics
NPI:1083478630
Name:LADEWIG, KEDRI (LCSW)
Entity Type:Individual
Prefix:
First Name:KEDRI
Middle Name:
Last Name:LADEWIG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-3123
Mailing Address - Country:US
Mailing Address - Phone:035-777-9253
Mailing Address - Fax:
Practice Address - Street 1:1181 DALLAS ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-3123
Practice Address - Country:US
Practice Address - Phone:303-577-7925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099264491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical