Healthcare Provider Details

I. General information

NPI: 1376527267
Provider Name (Legal Business Name): WILLIAM STAUDENMAIER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/03/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MADISON ST SUITE 306
DENVER CO
80206-5418
US

IV. Provider business mailing address

90 MADISON ST SUITE 306
DENVER CO
80206-5418
US

V. Phone/Fax

Practice location:
  • Phone: 303-698-9000
  • Fax: 303-388-8008
Mailing address:
  • Phone: 303-698-9000
  • Fax: 303-388-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number715
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: