Healthcare Provider Details

I. General information

NPI: 1972099984
Provider Name (Legal Business Name): BETHANY MARIE HOLLENBECK M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 BLAKE STREET
DENVER CO
80205
US

IV. Provider business mailing address

3675 S DALLAS ST UNIT G206
AURORA CO
80014-7278
US

V. Phone/Fax

Practice location:
  • Phone: 720-419-2187
  • Fax:
Mailing address:
  • Phone: 703-307-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: