Provider Demographics
NPI:1851520951
Name:BARRETT, AUDREY MARIA (AUDREY BARRETT, LAC)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:MARIA
Last Name:BARRETT
Suffix:
Gender:F
Credentials:AUDREY BARRETT, LAC
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:MARIA
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2830 NORTH AVE
Mailing Address - Street 2:C-5B 123
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-5369
Mailing Address - Country:US
Mailing Address - Phone:970-712-1886
Mailing Address - Fax:
Practice Address - Street 1:2470 F RD
Practice Address - Street 2:SUITE 8
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1279
Practice Address - Country:US
Practice Address - Phone:970-712-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1362171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist