Provider Demographics
NPI:1376527267
Name:STAUDENMAIER, WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:STAUDENMAIER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MADISON ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5418
Mailing Address - Country:US
Mailing Address - Phone:303-698-9000
Mailing Address - Fax:303-388-8008
Practice Address - Street 1:90 MADISON ST
Practice Address - Street 2:SUITE 306
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5418
Practice Address - Country:US
Practice Address - Phone:303-698-9000
Practice Address - Fax:303-388-8008
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO715103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO715OtherLICENSED PSYCHOLOGIST
CO07007156Medicaid
CO07007156Medicaid