Provider Demographics
NPI:1982050027
Name:SALMON, KATHLEEN (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SALMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 TALISMAN PL
Mailing Address - Street 2:UNIT A
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2060
Mailing Address - Country:US
Mailing Address - Phone:908-400-0311
Mailing Address - Fax:
Practice Address - Street 1:2955 VALMONT RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1396
Practice Address - Country:US
Practice Address - Phone:908-400-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-08
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009920772104100000X
CONLC.0105493172V00000X
COCSW.099245611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172V00000XOther Service ProvidersCommunity Health Worker