Provider Demographics
NPI:1659649119
Name:LANDRY, KATHERINE ANGELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANGELLE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 S OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-5749
Mailing Address - Country:US
Mailing Address - Phone:720-630-1481
Mailing Address - Fax:
Practice Address - Street 1:5001 S PARKER RD STE 215
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1183
Practice Address - Country:US
Practice Address - Phone:303-615-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099245301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1659649119Medicaid