Provider Demographics
NPI:1851442636
Name:LAUTMANN, LEE (PSYD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:LAUTMANN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E SIMPSON ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2394
Mailing Address - Country:US
Mailing Address - Phone:720-562-0523
Mailing Address - Fax:303-661-0818
Practice Address - Street 1:400 E SIMPSON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2394
Practice Address - Country:US
Practice Address - Phone:720-562-0523
Practice Address - Fax:303-661-0818
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1631103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC23679Medicare ID - Type Unspecified
COR18806Medicare UPIN