Healthcare Provider Details

I. General information

NPI: 1528970159
Provider Name (Legal Business Name): RAYMOND SCHWAB ADDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 PINE BLUFF RD
DIVIDE CO
80814-8924
US

IV. Provider business mailing address

199 PINE BLUFF RD
DIVIDE CO
80814-8924
US

V. Phone/Fax

Practice location:
  • Phone: 719-661-3746
  • Fax:
Mailing address:
  • Phone: 719-661-3746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0000661
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: