Individual
EILEEN M VANDERGRIFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4162 WESTCLIFFE CT, BOULDER, CO 80301-1759
(303) 593-2201
Mailing address
4162 WESTCLIFFE CT, BOULDER, CO 80301-1759
(303) 593-2201
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS006856L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
783861
HIGHMARK
PA
05
—
783861
—
PA
Enumeration date
01/16/2007
Last updated
07/25/2017
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