Healthcare Provider Details

I. General information

NPI: 1811290570
Provider Name (Legal Business Name): MONICA PAIGE BUETTEL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E RAILROAD AVE SUITE #500
FORT MORGAN CO
80701-3145
US

IV. Provider business mailing address

29511 3RD ST PO BOX 741
SNYDER CO
80750-8005
US

V. Phone/Fax

Practice location:
  • Phone: 970-396-9523
  • Fax: 970-367-1924
Mailing address:
  • Phone: 970-396-9523
  • Fax: 970-367-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3531
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: