Individual
ELLEN WALL TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4800 RIVERBEND RD, SUITE 200, BOULDER, CO 80301-2636
(303) 415-8850
(303) 415-8870
Mailing address
5450 WESTERN AVE, BOULDER, CO 80301-2709
(303) 415-8850
(303) 415-8870
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW.00000120
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71927760
—
CO
Enumeration date
04/08/2008
Last updated
11/10/2017
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