Healthcare Provider Details

I. General information

NPI: 1982012746
Provider Name (Legal Business Name): JONNA VON SCHULZ PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JONNA L HALPHEN

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W 121ST AVE
WESTMINSTER CO
80234-2302
US

IV. Provider business mailing address

7469 SPY GLASS CT
BOULDER CO
80301-3717
US

V. Phone/Fax

Practice location:
  • Phone: 601-467-2507
  • Fax: 601-467-2507
Mailing address:
  • Phone: 601-467-2507
  • Fax: 601-467-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY.0004347
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-9703
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: