Provider Demographics
NPI:1700241361
Name:EKKER, MONIQUE JULIA
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:JULIA
Last Name:EKKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13576 COUNTY RD 1
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:CO
Mailing Address - Zip Code:80816-9001
Mailing Address - Country:US
Mailing Address - Phone:719-235-7473
Mailing Address - Fax:
Practice Address - Street 1:13576 COUNTY RD 1
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:CO
Practice Address - Zip Code:80816-9001
Practice Address - Country:US
Practice Address - Phone:719-235-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0105810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health