Individual
KAILE MYSTIQUE WIDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
115 GRAND AVE, DELTA, CO 81416-2000
(970) 874-0464
Mailing address
115 GRAND AVE, DELTA, CO 81416-2000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SWC.0000001235
CO
Other
Enumeration date
08/22/2023
Last updated
08/22/2023
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