Provider Demographics
NPI:1295554574
Name:ATONGDEM, PRISCA A
Entity type:Individual
Prefix:
First Name:PRISCA
Middle Name:A
Last Name:ATONGDEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PORTIA
Other - Middle Name:
Other - Last Name:ATONGDEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2367 S XANADU WAY APT 207
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2110
Mailing Address - Country:US
Mailing Address - Phone:203-725-8421
Mailing Address - Fax:
Practice Address - Street 1:2367 S XANADU WAY APT 207
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2110
Practice Address - Country:US
Practice Address - Phone:203-725-8421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst