Provider Demographics
NPI:1467673871
Name:STAHLMAN, KATHY ROSEANN (LAC)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ROSEANN
Last Name:STAHLMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COUNTY ROAD 127 TRLR 8
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-9265
Mailing Address - Country:US
Mailing Address - Phone:970-945-2097
Mailing Address - Fax:970-945-2097
Practice Address - Street 1:3950 MIDLAND AVE
Practice Address - Street 2:3
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4603
Practice Address - Country:US
Practice Address - Phone:970-945-2097
Practice Address - Fax:970-945-2097
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO359171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO359OtherLICENSED ACUPUNCTURIST
CO359OtherLAC ACPUNCTURISTT