Local City Search for Psychiatrists, Psychologists, Therapists, Counselors and Mental Health Treatment CentersKATHLEEN LAUREN EDD PLLC
Clinical Neuropsychologist
Fort Collins, Colorado
Provider NPI: 1356367197
Organization Information:Organization Name: KATHLEEN LAUREN EDD PLLC
Organization is not Subpart
Authorized Official: JESSICA L FREITAG BILLING AGENT 970-6860970
Practice Location:
4674 SNOW MESA DR STE 100 FORT COLLINS, CO 80528 US
Tel: 970-221-1073 Fax: 970-221-9380
Business Mailing Address:
PO BOX 492 WINDSOR, CO 80550 US
Tel: 970-686-0970 Fax: 970-686-0341
Entity Type: Organization
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Organization is not Subpart
Authorized Official: JESSICA L FREITAG BILLING AGENT 970-6860970
Practice Location:
4674 SNOW MESA DR STE 100 FORT COLLINS, CO 80528 US
Tel: 970-221-1073 Fax: 970-221-9380
Business Mailing Address:
PO BOX 492 WINDSOR, CO 80550 US
Tel: 970-686-0970 Fax: 970-686-0341
Entity Type: Organization
Taxonomy:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 103G00000X | Behavioral Health & Social Service Providers Clinical Neuropsychologist | CO | 1990 |
Other Provider Identifiers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 69323780 | CO | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
