Provider Demographics
NPI:1336650191
Name:RABAGO, KATELYN (MS, PSYD STUDENT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:RABAGO
Suffix:
Gender:F
Credentials:MS, PSYD STUDENT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:RABAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:305 KNOBCONE DR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5711
Mailing Address - Country:US
Mailing Address - Phone:612-360-0057
Mailing Address - Fax:
Practice Address - Street 1:7100 BROADWAY STE 6
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2915
Practice Address - Country:US
Practice Address - Phone:303-596-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician