Individual
BALQIS KHAIRUNNISA NUGROHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1613 E PROSPECT RD. STE110, FORT COLLINS, CO 80525
(970) 297-7704
Mailing address
300 INTERNATIONAL PKWY STE 200, LAKE MARY, FL 32746-5028
(866) 610-0580
(866) 611-1558
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
CO
Other
Enumeration date
03/13/2026
Last updated
03/13/2026
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