MEDICARE: DR. ALLISON SIAN MARGULIES PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist
2	103TM1800X	Intellectual & Developmental Disabilities Psychologist	PSY3470	CO
3	103TC0700X	Clinical Psychologist	3470	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12129278	OTHER		CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184760514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON SIAN MARGULIES PH.D.

Provider Business Mailing Address
First Line	:	4408 JOHN F KENNEDY PKWY APT B301
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3350
Country	:	US
Telephone Number	:	301-642-3029
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 BOARDWALK DR UNIT 5A
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3093
Country	:	US
Telephone Number	:	970-223-2256
Fax Number	:	970-223-2324

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	11/28/2018

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