Healthcare Provider Details

I. General information

NPI: 1265356992
Provider Name (Legal Business Name): KATHRYN GRACE BOLLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 PROSPECT PKWY
FORT COLLINS CO
80525-9707
US

IV. Provider business mailing address

1613 PROSPECT PKWY
FORT COLLINS CO
80525-9707
US

V. Phone/Fax

Practice location:
  • Phone: 970-377-9401
  • Fax:
Mailing address:
  • Phone: 970-377-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: