| Doctor Name: | MS. ELLEN GRACE VAN BOCKERN |
| NPI Number: | 1457768418 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | CSW.09924058 |
| Business Practice Address: | 480 East Agate Ave Granby, CO - 80446 |
| Business Phone Number: | 9708872179 |
| Business Fax Number: | 9708879311 |
| Mailing Address: | 715 Horizon Dr, Ste 225 GRAND JUNCTION |
| State: | CO |
| Postal Code: | 815068700 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/22/2014 |
| NPI Last Update Date: | 08/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | CSW.09924058 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |