Provider Demographics
NPI:1972099984
Name:HOLLENBECK, BETHANY MARIE (MED)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:HOLLENBECK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 S DALLAS ST UNIT G206
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-7278
Mailing Address - Country:US
Mailing Address - Phone:703-307-7840
Mailing Address - Fax:
Practice Address - Street 1:3425 BLAKE STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205
Practice Address - Country:US
Practice Address - Phone:720-419-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty