Provider Demographics
NPI:1164617635
Name:DEKOWZAN, MARY ANNETTE (CMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNETTE
Last Name:DEKOWZAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-0997
Mailing Address - Country:US
Mailing Address - Phone:720-301-2583
Mailing Address - Fax:
Practice Address - Street 1:8230 S COLORADO BLVD
Practice Address - Street 2:SUITE B-3
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3689
Practice Address - Country:US
Practice Address - Phone:303-770-6355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist