Provider Demographics
NPI:1114011558
Name:KAAKE, GARY LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:KAAKE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8790 W COLFAX AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4092
Mailing Address - Country:US
Mailing Address - Phone:303-234-0827
Mailing Address - Fax:303-234-1771
Practice Address - Street 1:8790 W COLFAX AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4092
Practice Address - Country:US
Practice Address - Phone:303-234-0827
Practice Address - Fax:303-234-1771
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1212103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO229797OtherCOMPSYCH
CO07012123Medicaid
CO470920477OtherTRICARE PROVIDER
CO90226OtherCIGNA BEHAVIORAL HEALTH
CO80256Medicare UPIN
CO07012123Medicaid
COC504608Medicare PIN
CO1629163720Medicare UPIN
COC504608Medicare ID - Type Unspecified