1194012583 NPI number — MS. GUDRUN A DILGER MED, MA, LPC, CACIII

Table of content: MS. GUDRUN A DILGER MED, MA, LPC, CACIII (NPI 1194012583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194012583 NPI number — MS. GUDRUN A DILGER MED, MA, LPC, CACIII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILGER
Provider First Name:
GUDRUN
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MED, MA, LPC, CACIII
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DILGER
Provider Other First Name:
AVANI
Provider Other Middle Name:
GUDRUN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MED, MA, LPC, CACIII
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1194012583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1790 30TH ST
Provider Second Line Business Mailing Address:
SUITE 245
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80301-1022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-859-5778
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1790 30TH ST
Provider Second Line Business Practice Location Address:
SUITE 245
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80301-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-859-5778
Provider Business Practice Location Address Fax Number:
303-449-2473
Provider Enumeration Date:
07/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  6186 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 4442 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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