Individual
GRACIE BODHOLDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2760 FIELDSTONE RD, COLORADO SPRINGS, CO 80919-3100
(719) 203-6904
(719) 203-6904
Mailing address
2760 FIELDSTONE RD, COLORADO SPRINGS, CO 80919-3100
(719) 203-6904
(719) 203-6904
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-176618
CO
Other
Enumeration date
07/22/2021
Last updated
07/22/2021
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