Healthcare Provider Details

I. General information

NPI: 1477600690
Provider Name (Legal Business Name): MARY L. KLATT DNP, RXN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST
DENVER CO
80220-3808
US

IV. Provider business mailing address

1055 CLERMONT ST
DENVER CO
80220-3808
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax: 303-393-5151
Mailing address:
  • Phone: 303-399-8020
  • Fax: 303-393-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number3075-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRXN.0101249-CNS
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: