Healthcare Provider Details

I. General information

NPI: 1376785907
Provider Name (Legal Business Name): NEURODEVELOPMENT CENTER OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 E. HARMONY #202
FORT COLLINS CO
80525-3210
US

IV. Provider business mailing address

608 E. HARMONY #202
FORT COLLINS CO
80525-3210
US

V. Phone/Fax

Practice location:
  • Phone: 970-282-4428
  • Fax: 970-282-4393
Mailing address:
  • Phone: 970-282-4428
  • Fax: 970-282-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2843
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number2843
License Number StateCO

VIII. Authorized Official

Name: DR. AARON E SKALICKY
Title or Position: OWNER / LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 970-282-4428