Provider Demographics
NPI:1548788672
Name:DUNLAP, STEPHANIE PECK (CSW09926800)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PECK
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:CSW09926800
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8156 S WADSWORTH BLVD UNIT E-156
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-9114
Mailing Address - Country:US
Mailing Address - Phone:303-578-0223
Mailing Address - Fax:
Practice Address - Street 1:2130 STOUT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2827
Practice Address - Country:US
Practice Address - Phone:303-293-2220
Practice Address - Fax:303-296-8826
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099268001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000186420Medicaid