Individual
DOMINIQUE COLE BLADOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1613 PROSPECT PARK WAY STE 110, FORT COLLINS, CO 80525-9707
(970) 377-9401
Mailing address
6107 ASHTON CT, FORT COLLINS, CO 80525-5898
(970) 219-9561
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/27/2018
Last updated
03/27/2018
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