Healthcare Provider Details

I. General information

NPI: 1508196635
Provider Name (Legal Business Name): KATHLEEN ST. JOHN MM, MT-BC, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 TENDERFOOT HILL RD SUITE 150
COLORADO SPRINGS CO
80906-2314
US

IV. Provider business mailing address

510 NORMAN DR
COLORADO SPRINGS CO
80911-1831
US

V. Phone/Fax

Practice location:
  • Phone: 719-213-4330
  • Fax: 719-352-3678
Mailing address:
  • Phone: 719-213-4330
  • Fax: 719-352-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number06784
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: