Provider Demographics
NPI:1740748243
Name:KLEKAMP, MOLLY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:KLEKAMP
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 BROADWAY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3189
Mailing Address - Country:US
Mailing Address - Phone:303-667-6647
Mailing Address - Fax:
Practice Address - Street 1:3050 BROADWAY ST STE 300
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3189
Practice Address - Country:US
Practice Address - Phone:303-667-6647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099258561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical