Healthcare Provider Details

I. General information

NPI: 1295365914
Provider Name (Legal Business Name): EMMA TANNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA GENTLEMAN

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 W JEFFERSON AVE STE 100
LAKEWOOD CO
80235-2015
US

IV. Provider business mailing address

7220 W JEFFERSON AVE STE 100
LAKEWOOD CO
80235-2015
US

V. Phone/Fax

Practice location:
  • Phone: 303-225-7673
  • Fax: 866-283-0595
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: