Provider Demographics
NPI:1588331276
Name:EGLI-DAVIS, INDIGO JORDAN
Entity type:Individual
Prefix:
First Name:INDIGO
Middle Name:JORDAN
Last Name:EGLI-DAVIS
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 1:919 W MOORHEAD CIR APT C
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6143
Mailing Address - Country:US
Mailing Address - Phone:515-231-8636
Mailing Address - Fax:
Practice Address - Street 1:685 BRIGGS ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-5022
Practice Address - Country:US
Practice Address - Phone:703-606-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst