Healthcare Provider Details

I. General information

NPI: 1427101708
Provider Name (Legal Business Name): KATHLEEN ANN LAUREN ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 CARIBOU DR SUITE 201
FORT COLLINS CO
80525-4338
US

IV. Provider business mailing address

2038 CARIBOU DR SUITE 201
FORT COLLINS CO
80525-4338
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-1073
  • Fax: 970-221-9380
Mailing address:
  • Phone: 970-221-1073
  • Fax: 970-221-9380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1990
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: