Individual
DR. GARY LEE KAAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
1212
CO
103TC0700X
Clinical Psychologist
Primary
1212
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07012123
—
CO
01
—
229797
COMPSYCH
CO
01
—
470920477
TRICARE PROVIDER
CO
01
—
90226
CIGNA BEHAVIORAL HEALTH
CO
Enumeration date
10/02/2006
Last updated
08/18/2008
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