Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 0007931 | CO |
NPI | 1639607724 |
---|---|
Provider Name | Devin Koetje |
First Address | Wheat Ridge, CO 80033-6712 |
Second Address | Wheat Ridge, CO 80033-3305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2017 |
Last Update Date | 01/06/2017 |