Provider Demographics
NPI:1497172886
Name:DITTRICK-NATHAN, KARIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:
Last Name:DITTRICK-NATHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 LANDMARK PL
Mailing Address - Street 2:#813
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1950
Mailing Address - Country:US
Mailing Address - Phone:303-865-7632
Mailing Address - Fax:
Practice Address - Street 1:5455 LANDMARK PLACE
Practice Address - Street 2:#813
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1955
Practice Address - Country:US
Practice Address - Phone:303-865-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0484454103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool