Provider Demographics
NPI:1417529728
Name:DEFORREST, ARYN M
Entity Type:Individual
Prefix:
First Name:ARYN
Middle Name:M
Last Name:DEFORREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARYN
Other - Middle Name:MARI
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2490 S JEBEL WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-8999
Mailing Address - Country:US
Mailing Address - Phone:970-571-2898
Mailing Address - Fax:
Practice Address - Street 1:2490 S JEBEL WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-8999
Practice Address - Country:US
Practice Address - Phone:970-571-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician