Provider Demographics
NPI:1730326810
Name:WIDGA, NICHOL LEE (BA)
Entity type:Individual
Prefix:
First Name:NICHOL
Middle Name:LEE
Last Name:WIDGA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 E DICKENSON PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6012
Mailing Address - Country:US
Mailing Address - Phone:303-504-6509
Mailing Address - Fax:303-782-0916
Practice Address - Street 1:2829 W 33RD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3231
Practice Address - Country:US
Practice Address - Phone:303-433-3944
Practice Address - Fax:303-433-9717
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor