Healthcare Provider Details

I. General information

NPI: 1609224104
Provider Name (Legal Business Name): CATHERINE CLONCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CARPENTER RD
FORT COLLINS CO
80525-4248
US

IV. Provider business mailing address

4989 N 3RD ST
LARAMIE WY
82072-9548
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-3500
  • Fax:
Mailing address:
  • Phone: 307-745-8997
  • Fax: 307-742-6146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: