Provider Demographics
NPI:1467647339
Name:KUECKE, NANCY B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:B
Last Name:KUECKE
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 1:2769 IRIS AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4405
Mailing Address - Country:US
Mailing Address - Phone:303-442-1036
Mailing Address - Fax:303-581-1030
Practice Address - Street 1:2769 IRIS AVE
Practice Address - Street 2:STE 102
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4405
Practice Address - Country:US
Practice Address - Phone:303-442-1036
Practice Address - Fax:303-581-1030
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO989361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health