Provider Demographics
NPI:1669481818
Name:TEDSTROM, ERIC BOWEN (MSW)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:BOWEN
Last Name:TEDSTROM
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20971 E SMOKY HILL RD
Mailing Address - Street 2:STE 215
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5186
Mailing Address - Country:US
Mailing Address - Phone:720-427-0731
Mailing Address - Fax:720-367-5239
Practice Address - Street 1:20971 E SMOKY HILL RD
Practice Address - Street 2:STE 215
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5186
Practice Address - Country:US
Practice Address - Phone:720-427-0731
Practice Address - Fax:720-367-5239
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9917291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical