Healthcare Provider Details

I. General information

NPI: 1841996717
Provider Name (Legal Business Name): STEFANIE WYCOFF RDH, OMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 14TH ST
BURLINGTON CO
80807-1609
US

IV. Provider business mailing address

1890 FAY ST
BURLINGTON CO
80807-2204
US

V. Phone/Fax

Practice location:
  • Phone: 719-346-4681
  • Fax:
Mailing address:
  • Phone: 719-648-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10639
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number905098
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: