Provider Demographics
NPI:1295177574
Name:LICHTENHAHN, CINDY L (MTR, CLT, LET-II)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:LICHTENHAHN
Suffix:
Gender:F
Credentials:MTR, CLT, LET-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:CO
Mailing Address - Zip Code:81643-0389
Mailing Address - Country:US
Mailing Address - Phone:970-755-0284
Mailing Address - Fax:
Practice Address - Street 1:514 28 1/4 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-4961
Practice Address - Country:US
Practice Address - Phone:970-241-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT 0009982174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist