| Rocky Mountain Memory Center Pllc | |
|
951 Laporte Ave Fort Collins CO 80521-2522 | |
| (970) 221-1073 | |
| Not Available |
| Full Name | Rocky Mountain Memory Center Pllc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 951 Laporte Ave, Fort Collins, Colorado |
| Authorized Official Name and Position | Kathleen A Lauren (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9702211073 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rocky Mountain Memory Center Pllc 2801 Remington St Ste 1 Fort Collins CO 80525-2566 Ph: (970) 221-1073 | Rocky Mountain Memory Center Pllc 951 Laporte Ave Fort Collins CO 80521-2522 Ph: (970) 221-1073 |
| NPI Number | 1982853073 |
|---|---|
| Provider Enumeration Date | 09/12/2008 |
| Last Update Date | 05/24/2012 |
| Medicare PECOS PAC ID | 9537226139 |
|---|---|
| Medicare Enrollment ID | O20090326000277 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982853073 | NPI | - | NPPES |
| 69323780 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 1990 (Colorado) | Primary |
| 225X00000X | Occupational Therapist | 1024531 (Colorado) | Secondary |
| Provider Name | Kathleen A Lauren |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427101708 PECOS PAC ID: 6800888637 Enrollment ID: I20040401000618 |
| Provider Name | Linda L Konopczynski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023087905 PECOS PAC ID: 0840435186 Enrollment ID: I20130314000373 |
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