| Eandd, Llc | |
|
1320 Ithaca Dr Boulder CO 80305-6334 | |
| (303) 358-9507 | |
| Not Available |
| Full Name | Eandd, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1320 Ithaca Dr, Boulder, Colorado |
| Authorized Official Name and Position | Jessica Koepf (DELEGATED OFFICIAL) |
| Authorized Official Contact | 3034443443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eandd, Llc 1320 Ithaca Dr Boulder CO 80305-6334 Ph: (303) 358-9507 | Eandd, Llc 1320 Ithaca Dr Boulder CO 80305-6334 Ph: (303) 358-9507 |
| NPI Number | 1528688140 |
|---|---|
| Provider Enumeration Date | 04/23/2020 |
| Last Update Date | 09/17/2020 |
| Certification Date | 09/17/2020 |
| Medicare PECOS PAC ID | 9931525656 |
|---|---|
| Medicare Enrollment ID | O20200811001587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528688140 | NPI | - | NPPES |
| 1003275439 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Thaddeus J Frye |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770146680 PECOS PAC ID: 7719303502 Enrollment ID: I20200803002677 |
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