Healthcare Provider Details

I. General information

NPI: 1669939187
Provider Name (Legal Business Name): VIDA MENDEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIDA HOUCK MSW

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3977 CRAWFORD CT
LOVELAND CO
80538-5595
US

IV. Provider business mailing address

PO BOX 2362
LOVELAND CO
80539-2362
US

V. Phone/Fax

Practice location:
  • Phone: 970-599-1539
  • Fax:
Mailing address:
  • Phone: 970-356-4015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09926645
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: