Provider Demographics
NPI:1578004511
Name:EDSTROM, GRACE (LCSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:EDSTROM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:JASMINE
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:3600 S YOSEMITE ST STE 1050
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-1852
Mailing Address - Country:US
Mailing Address - Phone:303-667-4557
Mailing Address - Fax:
Practice Address - Street 1:730 W HAMPDEN AVE STE 200
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2129
Practice Address - Country:US
Practice Address - Phone:720-974-7466
Practice Address - Fax:303-953-7274
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099246711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical