NPIMap

Organization Active NPI

Kathleen Lauren Edd PLLC

  • Clinical Neuropsychologist
  • Fort Collins, CO
National Provider Identifier
1356367197
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
1990 Issued in CO
Legal business name
KATHLEEN LAUREN EDD PLLC
Practice address
4674 Snow Mesa Dr
Ste 100
Fort Collins, CO 80528
Phone
(970) 221-1073
Fax
(970) 221-9380
NPI assigned
Jul 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessica L Freitag
Title
Billing Agent
Phone
(970) 686-0970

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X 1990 CO Primary

Addresses

Primary practice location

4674 Snow Mesa Dr
Ste 100
Fort Collins, CO 80528

Mailing address

PO Box 492
Windsor, CO 80550
Phone (970) 686-0970

Other identifiers 1

IdentifierTypeStateIssuer
69323780MedicaidCO

Other names 1

  • Kathleen Lauren Other name

National Provider Directory

National Provider Directory
Tax ID family
Kathleen Lauren2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356367197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 492",
            "city": "WINDSOR",
            "state": "CO",
            "postal_code": "80550",
            "telephone_number": "970-686-0970",
            "fax_number": "970-686-0341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4674 SNOW MESA DR",
            "address_2": "STE 100",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "80528",
            "telephone_number": "970-221-1073",
            "fax_number": "970-221-9380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHLEEN LAUREN EDD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FREITAG",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING AGENT",
        "authorized_official_telephone_number": "970-686-0970"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "CO",
            "license": "1990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "69323780",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kathleen Lauren",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.