Kaitlyn Alexandra Willecke

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9922301 Issued in CO

Practice address

4851 Independence St
Suite 200
Wheat Ridge, CO 80033-6715

Phone

(303) 425-0300

Fax

(303) 432-5071

NPI assigned

Dec 14, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kaitlyn Alexandra Kurzdorfer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546560000000",
    "number": "1073988267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4851 INDEPENDENCE ST",
            "address_2": "SUITE 200",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336715",
            "telephone_number": "303-425-0300",
            "fax_number": "303-432-5071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4851 INDEPENDENCE ST",
            "address_2": "SUITE 200",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800336715",
            "telephone_number": "303-425-0300",
            "fax_number": "303-432-5071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLECKE",
        "first_name": "KAITLYN",
        "middle_name": "ALEXANDRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-14",
        "last_updated": "2019-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "9922301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "KURZDORFER",
            "middle_name": "ALEXANDRA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Justin Bennett Wiley
• Joseph Will, DDS, MS
• Clara Wille
• William L Saber MD PC
• John Stewart Williams, MD
• Kelly A Williams
• Kelly Jane Williams, LCSW
• Kristina PC Williams, LCSW

• Clinical Social Worker in Wheat Ridge, CO
• Providers in Wheat Ridge, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.