Provider Demographics
NPI:1194012583
Name:DILGER, GUDRUN A (MED, MA, LPC, CACIII)
Entity Type:Individual
Prefix:MS
First Name:GUDRUN
Middle Name:A
Last Name:DILGER
Suffix:
Gender:F
Credentials:MED, MA, LPC, CACIII
Other - Prefix:MS
Other - First Name:AVANI
Other - Middle Name:GUDRUN
Other - Last Name:DILGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, MA, LPC, CACIII
Mailing Address - Street 1:1790 30TH ST
Mailing Address - Street 2:SUITE 245
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1022
Mailing Address - Country:US
Mailing Address - Phone:303-859-5778
Mailing Address - Fax:
Practice Address - Street 1:1790 30TH ST
Practice Address - Street 2:SUITE 245
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1022
Practice Address - Country:US
Practice Address - Phone:303-859-5778
Practice Address - Fax:303-449-2473
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6186101YA0400X
CO4442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health