Provider Demographics
NPI:1528391026
Name:WADGINSKI, AMY A (BEHAVIORAL SUPPORT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:WADGINSKI
Suffix:
Gender:F
Credentials:BEHAVIORAL SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 17TH AVE
Mailing Address - Street 2:1027
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1233
Mailing Address - Country:US
Mailing Address - Phone:619-997-5216
Mailing Address - Fax:
Practice Address - Street 1:215 SAINT PAUL ST
Practice Address - Street 2:STE. 205
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5124
Practice Address - Country:US
Practice Address - Phone:303-333-4062
Practice Address - Fax:303-333-4097
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor