| Lisa M. Vonderhaar, Ph.d.,llc | |
|
10291 Chippewa Cir Salida CO 81201-9596 | |
| (970) 531-0574 | |
| Not Available |
| Full Name | Lisa M. Vonderhaar, Ph.d.,llc |
|---|---|
| Speciality | Psychologist |
| Location | 10291 Chippewa Cir, Salida, Colorado |
| Authorized Official Name and Position | Lisa Maret Vonderhaar (OWNER/PSYCHOLOGIST) |
| Authorized Official Contact | 9705310574 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa M. Vonderhaar, Ph.d.,llc 10291 Chippewa Cir Salida CO 81201-9596 Ph: (970) 531-0574 | Lisa M. Vonderhaar, Ph.d.,llc 10291 Chippewa Cir Salida CO 81201-9596 Ph: (970) 531-0574 |
| NPI Number | 1912341983 |
|---|---|
| Provider Enumeration Date | 04/22/2013 |
| Last Update Date | 11/09/2022 |
| Certification Date | 11/09/2022 |
| Medicare PECOS PAC ID | 7416183439 |
|---|---|
| Medicare Enrollment ID | O20131122000192 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912341983 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2106 (Colorado) | Primary |
| Provider Name | Lisa M Vonderhaar |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1114086410 PECOS PAC ID: 0941102685 Enrollment ID: I20040123000241 |
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