Provider Demographics
NPI:1124652607
Name:SCHWENKE, ALESIA NICHOLE (MA)
Entity type:Individual
Prefix:
First Name:ALESIA
Middle Name:NICHOLE
Last Name:SCHWENKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 17TH ST STE 146
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1508
Mailing Address - Country:US
Mailing Address - Phone:303-997-0305
Mailing Address - Fax:
Practice Address - Street 1:565 WEST 96TH AVENUE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260
Practice Address - Country:US
Practice Address - Phone:303-997-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-19-40328103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst