Provider Demographics
NPI:1992959829
Name:BOWER-WAGNER, KIMBERLIE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLIE
Middle Name:ANN
Last Name:BOWER-WAGNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6444 E 17TH AVENUE PKWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1614
Mailing Address - Country:US
Mailing Address - Phone:303-370-1399
Mailing Address - Fax:
Practice Address - Street 1:1045 ACOMA ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4029
Practice Address - Country:US
Practice Address - Phone:303-370-1399
Practice Address - Fax:866-752-0379
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW9915941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical