Provider Demographics
NPI:1831119569
Name:FIESTER, KAREN DEBORAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:DEBORAH
Last Name:FIESTER
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 1:1113 SPRUCE ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4001
Mailing Address - Country:US
Mailing Address - Phone:303-449-3028
Mailing Address - Fax:303-938-5005
Practice Address - Street 1:1113 SPRUCE ST
Practice Address - Street 2:SUITE 501
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4001
Practice Address - Country:US
Practice Address - Phone:303-449-3028
Practice Address - Fax:303-938-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO828103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94616Medicare UPIN