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General NPI Number Information
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NPI Number | 1255276200
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Entity Type | Organization
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Legal Business Name | CHILDREN'S SPECIALTY CLINIC OF SAN LUIS VALLEY
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Dates
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Enumeration Date | 04/23/2026
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Last Update Date | 04/23/2026
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Provider Practice Location Address
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Address Line | 10 RUPERT ST
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City | MONTE VISTA
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State | CO
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Zip | 81144-1042
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Country | US
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Telephone | 719-852-3742
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Fax | 719-852-2559
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Provider Business Mailing Address
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Address Line | 10 RUPERT ST
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City | MONTE VISTA
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State | CO
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Zip | 81144-1042
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Country | US
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Telephone | 719-852-3742
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Fax | 719-852-2559
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Authorized Official
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Title or Position | COO
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Name | JENNIFER L CLUTTER
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Credential |
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Telephone | 719-852-3742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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