Healthcare Provider Details

I. General information

NPI: 1275332207
Provider Name (Legal Business Name): DEIDRA HOLCOMB BARLOW RD,LD, CSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 WILDWOOD LN
CASTLE ROCK CO
80104-9477
US

IV. Provider business mailing address

1331 WILDWOOD LN
CASTLE ROCK CO
80104-9477
US

V. Phone/Fax

Practice location:
  • Phone: 720-415-9883
  • Fax:
Mailing address:
  • Phone: 720-415-9883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number325
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2023078
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number885042
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number885042
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: