Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003437229 |
---|---|
Provider Name | Mara Vinton |
First Address | Fort Collins, CO 80521-3334 |
Second Address | Aurora, CO 80045-7211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2020 |
Last Update Date | 28/04/2020 |