| Neurofeedback Clinic Of Northern Colorado Llc | |
|
4115 Boardwalk Drive, Suite 100 Fort Collins CO 80525-5945 | |
| (970) 493-4580 | |
| (970) 797-2859 |
| Full Name | Neurofeedback Clinic Of Northern Colorado Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4115 Boardwalk Drive, Suite 100, Fort Collins, Colorado |
| Authorized Official Name and Position | Lisa Pendleton (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9704934580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurofeedback Clinic Of Northern Colorado Llc 4115 Boardwalk Dr Suite 100 Fort Collins CO 80525-5945 Ph: (970) 493-4580 | Neurofeedback Clinic Of Northern Colorado Llc 4115 Boardwalk Drive, Suite 100 Fort Collins CO 80525-5945 Ph: (970) 493-4580 |
| NPI Number | 1659794477 |
|---|---|
| Provider Enumeration Date | 01/30/2014 |
| Last Update Date | 09/08/2015 |
| Medicare PECOS PAC ID | 6406162353 |
|---|---|
| Medicare Enrollment ID | O20150909000093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659794477 | NPI | - | NPPES |
| Provider Name | Lesley Sanfilippo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215221270 PECOS PAC ID: 0840427563 Enrollment ID: I20181024002938 |
| Provider Name | Kellie Burns |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093093684 PECOS PAC ID: 6204163066 Enrollment ID: I20190816000946 |
| Provider Name | Jodie Ball |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356850846 PECOS PAC ID: 2961821178 Enrollment ID: I20201007000824 |
| Provider Name | Alix Dinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073157962 PECOS PAC ID: 4385063502 Enrollment ID: I20201007001421 |
| Provider Name | Leslie Lynn Larsen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053865915 PECOS PAC ID: 1355735432 Enrollment ID: I20220307001841 |
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