Individual
AMANDA JOAN EDMISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1421 S POTOMAC ST, AURORA, CO 80012-4535
(970) 310-3406
Mailing address
15072 E GUNNISON PL, AURORA, CO 80012-5742
(319) 621-1276
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LSW.0009922847
CO
1041C0700X
Clinical Social Worker
Primary
CSW.09928816
CO
Other
Enumeration date
05/10/2022
Last updated
12/03/2022
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