Individual
SAMANTHA GAULT-BLANCHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RP
Contact information
Practice address
6535 S DAYTON ST, GREENWOOD VILLAGE, CO 80111-6125
(720) 895-1000
(720) 895-8000
Mailing address
4480 RAY CIR APT A, FORT CARSON, CO 80902-1037
(602) 218-1231
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
0110852
CO
Other
Enumeration date
07/21/2021
Last updated
07/21/2021
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