Healthcare Provider Details

I. General information

NPI: 1306029129
Provider Name (Legal Business Name): JILL A. KUHN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W DRAKE RD SUITE 220
FORT COLLINS CO
80526-8115
US

IV. Provider business mailing address

PO BOX 270674
FORT COLLINS CO
80527-0674
US

V. Phone/Fax

Practice location:
  • Phone: 970-219-9206
  • Fax:
Mailing address:
  • Phone: 970-219-9206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3166
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: