Provider Demographics
NPI:1720176720
Name:WINTER, PATRICIA L (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:WINTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:22462 COUNTY ROAD 287
Mailing Address - Street 2:
Mailing Address - City:NATHROP
Mailing Address - State:CO
Mailing Address - Zip Code:81236
Mailing Address - Country:US
Mailing Address - Phone:719-239-0765
Mailing Address - Fax:719-395-8200
Practice Address - Street 1:112 MILL STREET
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211
Practice Address - Country:US
Practice Address - Phone:719-395-8200
Practice Address - Fax:719-395-8200
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1962103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO473988Medicare ID - Type UnspecifiedGROUP ID
CO473998Medicare ID - Type UnspecifiedINDIVIDUAL ID