Provider Demographics
NPI:1174206130
Name:HOCKER, SHAE LYNN
Entity type:Individual
Prefix:
First Name:SHAE
Middle Name:LYNN
Last Name:HOCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAE
Other - Middle Name:LYNN
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 S MONACO PKWY APT 706
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7200 S ALTON WAY STE A120
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2234
Practice Address - Country:US
Practice Address - Phone:720-935-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000278101YA0400X
CO0019966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)