Provider Demographics
NPI:1003241480
Name:HARTKE, CLAUDIA (PHD, SEP)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:
Last Name:HARTKE
Suffix:
Gender:F
Credentials:PHD, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 BROADWAY ST STE 103
Mailing Address - Street 2:PMB 153
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-1161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3005 47TH ST STE F4
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5550
Practice Address - Country:US
Practice Address - Phone:408-997-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28369103T00000X
COPSY0004810103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist