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General NPI Number Information
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NPI Number | 1114137569
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Entity Type | Organization
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Legal Business Name | PIKES PEAK PATHWAYS, PIKES PEAK BOCES
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 828 WOOTEN RD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80915-3520
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Country | US
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Telephone | 719-635-6333
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Fax | 719-380-6249
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Provider Business Mailing Address
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Address Line | 828 WOOTEN RD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80915-3520
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Country | US
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Telephone | 719-635-6333
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Fax | 719-380-6249
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Authorized Official
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Title or Position | DIRECTOR
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Name | DENISE HARTMAN
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Credential | MED
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Telephone | 719-635-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | CO
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