Provider Demographics
NPI:1912227745
Name:KAUFMAN, JOANNE L (NCMT)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:L
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:DEL NORTE
Mailing Address - State:CO
Mailing Address - Zip Code:81132-2276
Mailing Address - Country:US
Mailing Address - Phone:719-580-6158
Mailing Address - Fax:
Practice Address - Street 1:625 CHERRY ST
Practice Address - Street 2:
Practice Address - City:DEL NORTE
Practice Address - State:CO
Practice Address - Zip Code:81132-2276
Practice Address - Country:US
Practice Address - Phone:719-580-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-2819171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMT2819OtherSTATE REGISTRATION NUMBER