Provider Demographics
NPI:1427208693
Name:ZOGLO, MARY BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:ZOGLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:NOWAKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:970 E RIVERBEND ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8016
Mailing Address - Country:US
Mailing Address - Phone:303-921-5687
Mailing Address - Fax:
Practice Address - Street 1:970 E RIVERBEND ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-8016
Practice Address - Country:US
Practice Address - Phone:303-921-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1282103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist