Provider Demographics
NPI:1316080112
Name:LADD, ANN (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:LADD
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 S MANGRUM PL
Mailing Address - Street 2:PO BOX 7164
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-3636
Mailing Address - Country:US
Mailing Address - Phone:719-647-1746
Mailing Address - Fax:
Practice Address - Street 1:279 S JOE MARTINEZ BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-5439
Practice Address - Country:US
Practice Address - Phone:719-251-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9929271041C0700X
OR32701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical