Provider Demographics
NPI:1225401557
Name:SEMANSKY, KATHLEEN (MED)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SEMANSKY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 N OGDEN ST APT 6
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1926
Mailing Address - Country:US
Mailing Address - Phone:650-271-4231
Mailing Address - Fax:
Practice Address - Street 1:3020 CARBON PL
Practice Address - Street 2:200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-6169
Practice Address - Country:US
Practice Address - Phone:650-271-4231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
CO0107156101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool