Healthcare Provider Details

I. General information

NPI: 1902624000
Provider Name (Legal Business Name): MARISSA PAIGE SCOWCROFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CENTER GREEN DR STE 120
BOULDER CO
80301-2364
US

IV. Provider business mailing address

3000 CENTER GREEN DR STE 120
BOULDER CO
80301-2364
US

V. Phone/Fax

Practice location:
  • Phone: 720-642-7019
  • Fax:
Mailing address:
  • Phone: 720-642-7019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90135
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: