Provider Information for 1982729927
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DIANE PUKAJLO LCSW
Sex: Female
NPI: 1982729927
Last Updated: 2019-03-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1982729927 | ||||||||||||
| Enumeration Date | 2007-03-20 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 16825 GUADALUPE CT PEYTON, CO 80831-9452 United States Phone: 719-482-6608 | Fax: | ||||||||||||
| Primary Practice Address | 3237 W CAREFREE CIR COLORADO SPRINGS, CO 80917-3004 United States Phone: 719-271-2496 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 1304 CHINOOK LN | ||||||||||||
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