Healthcare Provider Details

I. General information

NPI: 1396984241
Provider Name (Legal Business Name): KATHLEEN H. MARTYNOWICZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17497 HIGHWAY 64 W
RANGELY CO
81648-2522
US

IV. Provider business mailing address

PO BOX 40
GLENWOOD SPRINGS CO
81602-0040
US

V. Phone/Fax

Practice location:
  • Phone: 970-675-8411
  • Fax: 970-675-2508
Mailing address:
  • Phone: 970-945-2241
  • Fax: 970-945-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1971
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: