Provider Demographics
NPI:1831546068
Name:COMMUNITY ROOTS MIDWIFE COLLECTIVE
Entity type:Organization
Organization Name:COMMUNITY ROOTS MIDWIFE COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAWULOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-803-7833
Mailing Address - Street 1:1903 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-1706
Mailing Address - Country:US
Mailing Address - Phone:303-803-7833
Mailing Address - Fax:
Practice Address - Street 1:1903 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-1706
Practice Address - Country:US
Practice Address - Phone:303-803-7833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO153176B00000X
CO154176B00000X
CO147176B00000X
CO86176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty