Provider Demographics
NPI:1912521238
Name:STADELE, EMMA KATHERINE (STUDENT CLINICIAN)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:KATHERINE
Last Name:STADELE
Suffix:
Gender:F
Credentials:STUDENT CLINICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7806 W 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4502
Mailing Address - Country:US
Mailing Address - Phone:303-808-7501
Mailing Address - Fax:
Practice Address - Street 1:2450 S VINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5264
Practice Address - Country:US
Practice Address - Phone:303-871-3736
Practice Address - Fax:303-871-7656
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health