Mark G Pendleton, PHD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

797 Issued in CO

Practice address

3015 47TH Street Suite E-3
Boulder, CO 80301-5437

Phone

(303) 444-6335

Fax

(303) 443-9641

NPI assigned

Jan 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185148800000",
    "number": "1992776678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 47TH STREET SUITE E-3",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803015437",
            "telephone_number": "303-444-6335",
            "fax_number": "303-443-9641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 47TH STREET SUITE E-3",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803015437",
            "telephone_number": "303-444-6335",
            "fax_number": "303-443-9641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDLETON",
        "first_name": "MARK",
        "middle_name": "G",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2007-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CO",
            "license": "797",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CO",
            "license": "797",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "CO",
            "license": "797",
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": "CO",
            "license": "797",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07106081",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aubrey Pelican
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• Emily Pena, MA, JD, LPC-C
• Bianca Marie Penaylillo
• Pendant Health LLC
• Emily M Pennuto
• Jay Pepitone
• Annette Ellen Percefull, ANP
• Travis Percival
• Alexus Laci Perea

• Clinical Neuropsychologist in Boulder, CO
• Providers in Boulder, CO by specialty
• Clinical Neuropsychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2007; 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.