Active NPI
Cora Klotzbach, PSYD
- Psychologist
- Evanston, WY
National Provider Identifier
1356495808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 302
- Practice address
- 724 Front Street
Suite 230
Evanston, WY 82930 - Phone
- (307) 789-6773
- Fax
- (307) 789-3244
- NPI assigned
- Jan 22, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 302 | WY | Primary |
Addresses
Primary practice location
724 Front Street
Suite 230
Evanston, WY 82930
Mailing address
724 Front Street
Suite 230
Evanston, WY 82930
Phone (307) 789-6773
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
724 Front St
Suite 230
Evanston, WY 82930-3589
Phone (307) 789-6773
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frontier Psychological Associates, L C | Psychologist | Current | Accepting new patients |
Locations
724 Front St
Ste 230
Evanston, WY 82930
Phone (307) 789-6773
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1356495808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "724 FRONT STREET",
"address_2": "SUITE 230",
"city": "EVANSTON",
"state": "WY",
"postal_code": "82930",
"telephone_number": "307-789-6773",
"fax_number": "307-789-3244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "724 FRONT STREET",
"address_2": "SUITE 230",
"city": "EVANSTON",
"state": "WY",
"postal_code": "82930",
"telephone_number": "307-789-6773",
"fax_number": "307-789-3244"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLOTZBACH",
"first_name": "CORA",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WY",
"license": "302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.