MEDICARE: COLORADO INTEGRATED SERVICES LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1619844123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO INTEGRATED SERVICES LLC

Provider Business Mailing Address
First Line	:	387 N CORONA ST # 1003
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-3939
Country	:	US
Telephone Number	:	720-445-4188
Fax Number	:

Provider Business Practice Location Address
First Line	:	387 N CORONA ST # 1003
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-3939
Country	:	US
Telephone Number	:	720-445-4188
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ISAAC WIEDER
Credential	:
Telephone Number	:	720-445-4188

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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Directions to “COLORADO INTEGRATED SERVICES LLC ” Practice Location

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