MEDICARE: DR. SAUL HOPPER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2651	CO

General Provider Information

NPI Number	:	1033202395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAUL HOPPER PH.D.

Provider Business Mailing Address
First Line	:	503 REMINGTON ST
Second Line	:	SUITE 102
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3074
Country	:	US
Telephone Number	:	970-221-0118
Fax Number	:	970-221-0014

Provider Business Practice Location Address
First Line	:	503 REMINGTON ST
Second Line	:	SUITE 102
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3074
Country	:	US
Telephone Number	:	970-221-0118
Fax Number	:	970-221-0014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	07/08/2007

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