Provider Demographics
NPI:1659436889
Name:WOLLESEN, CHARLOTTE MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:WOLLESEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3280 W COUNTY ROAD 8
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-9560
Mailing Address - Country:US
Mailing Address - Phone:970-532-3183
Mailing Address - Fax:970-532-3183
Practice Address - Street 1:1333 IRIS AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2226
Practice Address - Country:US
Practice Address - Phone:303-413-6255
Practice Address - Fax:303-449-6029
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health