Provider Demographics
NPI:1821570813
Name:ROBERTS, KATHERINE ELYSE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELYSE
Last Name:ROBERTS
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 1:8965 E FLORIDA AVE APT 3-208
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2812
Mailing Address - Country:US
Mailing Address - Phone:512-534-7073
Mailing Address - Fax:
Practice Address - Street 1:390 UNION BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-6514
Practice Address - Country:US
Practice Address - Phone:512-534-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician