Provider Demographics
NPI:1629693197
Name:KOGER, STACIE LURA ANN
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:LURA ANN
Last Name:KOGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5031 S ULSTER ST APT 1530
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2436
Mailing Address - Country:US
Mailing Address - Phone:317-501-7225
Mailing Address - Fax:
Practice Address - Street 1:5031 S ULSTER ST APT 1530
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2436
Practice Address - Country:US
Practice Address - Phone:317-501-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst