Individual
DIANE JO DETTLOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
35815 ROAD P.5, MANCOS, CO 81328-8798
(970) 570-9673
Mailing address
35815 ROAD P.5, MANCOS, CO 81328-8798
(970) 570-9673
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW.09925569
CO
Other
Enumeration date
11/04/2022
Last updated
11/04/2022
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