Healthcare Provider Details

I. General information

NPI: 1083354633
Provider Name (Legal Business Name): NEW PEAKS NEUROPSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 29TH ST STE 200
BOULDER CO
80303-2316
US

IV. Provider business mailing address

PO BOX 273336
FORT COLLINS CO
80527-3336
US

V. Phone/Fax

Practice location:
  • Phone: 303-200-4780
  • Fax:
Mailing address:
  • Phone: 303-444-3443
  • Fax: 970-221-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA KOEPF
Title or Position: BILLING CONTRACTING MANAGER
Credential:
Phone: 303-444-3443