Provider Demographics
NPI:1417558578
Name:VIGESAA, TEAGAN W (MSW)
Entity Type:Individual
Prefix:
First Name:TEAGAN
Middle Name:W
Last Name:VIGESAA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 E JEWELL AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4624
Mailing Address - Country:US
Mailing Address - Phone:406-696-9285
Mailing Address - Fax:
Practice Address - Street 1:4242 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-2618
Practice Address - Country:US
Practice Address - Phone:303-325-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.00000001541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical