Provider Demographics
NPI:1639196462
Name:WISOTT, BARBARA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:WISOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:PACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:155 VAN GORDON ST
Mailing Address - Street 2:SUITE 395
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1709
Mailing Address - Country:US
Mailing Address - Phone:303-914-2688
Mailing Address - Fax:303-914-2682
Practice Address - Street 1:155 VAN GORDON ST
Practice Address - Street 2:SUITE 395
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1709
Practice Address - Country:US
Practice Address - Phone:303-914-2688
Practice Address - Fax:303-914-2682
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical