Provider Demographics
NPI:1285607234
Name:STAUDENMAYER, HERMAN (PHD)
Entity type:Individual
Prefix:
First Name:HERMAN
Middle Name:
Last Name:STAUDENMAYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 E EVANS AVE
Mailing Address - Street 2:20-B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-5311
Mailing Address - Country:US
Mailing Address - Phone:303-758-8934
Mailing Address - Fax:303-758-6840
Practice Address - Street 1:5800 E EVANS AVE
Practice Address - Street 2:20-B
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5311
Practice Address - Country:US
Practice Address - Phone:303-758-8934
Practice Address - Fax:303-758-6840
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07104599Medicaid
CO07104599Medicaid