Healthcare Provider Details

I. General information

NPI: 1902153786
Provider Name (Legal Business Name): JANET D SEVERANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 10/01/2012
Certification Date:
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 Number591
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: