Provider Demographics
NPI:1174778377
Name:LEDEZMA, GUADALUPE (PHD)
Entity type:Individual
Prefix:DR
First Name:GUADALUPE
Middle Name:
Last Name:LEDEZMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7475 DAKIN ST
Mailing Address - Street 2:SUITE 620
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-6926
Mailing Address - Country:US
Mailing Address - Phone:303-913-2883
Mailing Address - Fax:720-890-7676
Practice Address - Street 1:7475 DAKIN ST
Practice Address - Street 2:SUITE 620
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-6926
Practice Address - Country:US
Practice Address - Phone:303-913-2883
Practice Address - Fax:720-890-7676
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2538103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical