Healthcare Provider Details

I. General information

NPI: 1730304833
Provider Name (Legal Business Name): LORI KLEIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CARPENTER RD
FORT COLLINS CO
80525-4248
US

IV. Provider business mailing address

305 CARPENTER RD
FORT COLLINS CO
80525-4248
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-3500
  • Fax: 970-292-1085
Mailing address:
  • Phone: 970-663-3500
  • Fax: 970-292-1085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09924027
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: