Basic Information
| Provider Information | |||||||||
| NPI: | 1184864373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEDLIN | ||||||||
| FirstName: | MARNY | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40 | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816020040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709452241 | ||||||||
| FaxNumber: | 9709455523 | ||||||||
| Practice Location | |||||||||
| Address1: | 0405 CASTLE CREEK RD | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | ASPEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816113125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709205555 | ||||||||
| FaxNumber: | 9709205557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2009 | ||||||||
| LastUpdateDate: | 08/21/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 000711 | NY | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 875 | CO | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.