Provider Demographics
NPI:1255655908
Name:HRDLICHKA, ALTHEA (CPM, LM, RM)
Entity Type:Individual
Prefix:MRS
First Name:ALTHEA
Middle Name:
Last Name:HRDLICHKA
Suffix:
Gender:F
Credentials:CPM, LM, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 JESSUP DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2550
Mailing Address - Country:US
Mailing Address - Phone:866-218-5769
Mailing Address - Fax:866-218-5769
Practice Address - Street 1:1817 JESSUP DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2550
Practice Address - Country:US
Practice Address - Phone:866-218-5769
Practice Address - Fax:866-218-5769
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY017176B00000X
AZB14620113374J00000X
CO0000173176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula