Provider Demographics
NPI:1104645787
Name:DITZLER, YAZMIN
Entity type:Individual
Prefix:
First Name:YAZMIN
Middle Name:
Last Name:DITZLER
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 1:19573 E PRINCETON PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-4507
Mailing Address - Country:US
Mailing Address - Phone:720-459-1078
Mailing Address - Fax:
Practice Address - Street 1:19573 E PRINCETON PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-4507
Practice Address - Country:US
Practice Address - Phone:720-459-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-24-329728106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician