Healthcare Provider Details

I. General information

NPI: 1255655908
Provider Name (Legal Business Name): ALTHEA HRDLICHKA CPM, LM, RM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 JESSUP DR
FORT COLLINS CO
80525-2550
US

IV. Provider business mailing address

1817 JESSUP DR
FORT COLLINS CO
80525-2550
US

V. Phone/Fax

Practice location:
  • Phone: 866-218-5769
  • Fax: 866-218-5769
Mailing address:
  • Phone: 866-218-5769
  • Fax: 866-218-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number017
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License NumberB14620113
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0000173
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: