Provider Demographics
NPI:1356485056
Name:DODD, TERRI L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:L
Last Name:DODD
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 1:4155 E JEWELL AVE
Mailing Address - Street 2:STE 804
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4512
Mailing Address - Country:US
Mailing Address - Phone:303-220-7870
Mailing Address - Fax:303-758-9788
Practice Address - Street 1:10350 E DAKOTA AVE STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1314
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CO989016104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
005209OtherKAISER-COMMERCIAL NUMBER
CO19054572Medicaid
COCOAAA3596Medicare PIN
CO19054572Medicaid
COCK11052Medicare PIN