Healthcare Provider Details

I. General information

NPI: 1255829438
Provider Name (Legal Business Name): KAITLIN ROLZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 CHAPEL HILLS DR APT B202
COLORADO SPRINGS CO
80920-5406
US

IV. Provider business mailing address

1520 CHAPEL HILLS DR APT B202
COLORADO SPRINGS CO
80920-5406
US

V. Phone/Fax

Practice location:
  • Phone: 605-592-0106
  • Fax: 605-592-0106
Mailing address:
  • Phone: 605-592-0106
  • Fax: 605-592-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69130
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: