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General NPI Number Information
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NPI Number | 1346673084
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Entity Type | Individual
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Provider Name | MARTHA JANE KIDD PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2013
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 5605 CEDAR CREEK VW SUITE 101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80915-5026
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Country | US
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Telephone | 719-243-9771
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Fax |
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Provider Business Mailing Address
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Address Line | 5605 CEDAR CREEK VW SUITE 101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80915-5026
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Country | US
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Telephone | 719-243-9771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY0003901
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1097
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License Number State | NC
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