1639183346 NPI number — MARY PATRICIA KARDOS MA, CACIII

Table of content: MARY PATRICIA KARDOS MA, CACIII (NPI 1639183346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639183346 NPI number — MARY PATRICIA KARDOS MA, CACIII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARDOS
Provider First Name:
MARY
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CACIII
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WYMAN
Provider Other First Name:
MARY
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639183346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26165 STANSBERRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONIFER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80433-9178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-809-2864
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4141 E DICKENSON PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222-6012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-504-1200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006

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:  6300 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 5048 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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