Provider Demographics
NPI:1548561632
Name:RUPP, LEANNE DIXON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:DIXON
Last Name:RUPP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:DIXON
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1410 N GRANT ST
Mailing Address - Street 2:STE B104
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203
Mailing Address - Country:US
Mailing Address - Phone:720-988-4780
Mailing Address - Fax:
Practice Address - Street 1:1410 N GRANT ST
Practice Address - Street 2:STE B104
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203
Practice Address - Country:US
Practice Address - Phone:720-988-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.000013511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical