Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY - 3706 | CO |
NPI | 1013100726 |
---|---|
Provider Name | Heather Bosler Carroll |
First Address | Denver, CO 80224-2549 |
Second Address | Denver, CO 80224-2549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2007 |
Last Update Date | 11/04/2012 |