Healthcare Provider Details

I. General information

NPI: 1881613156
Provider Name (Legal Business Name): MICHAEL KERRIGAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3649 S NEWLAND ST
DENVER CO
80235-2622
US

IV. Provider business mailing address

3649 S NEWLAND ST
DENVER CO
80235-2622
US

V. Phone/Fax

Practice location:
  • Phone: 303-528-6831
  • Fax:
Mailing address:
  • Phone: 303-988-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1426
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: