Provider Demographics
NPI:1124247820
Name:BASSETT, STEPHANIE ALLISON
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ALLISON
Last Name:BASSETT
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 1:5982 STAGECOACH AVE
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5585
Mailing Address - Country:US
Mailing Address - Phone:720-231-5434
Mailing Address - Fax:
Practice Address - Street 1:401 E SIMPSON ST
Practice Address - Street 2:STE 103
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2327
Practice Address - Country:US
Practice Address - Phone:303-926-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator