OrganizationActive
Icn PLLC
NPI 1487192076 · Clinical Neuropsychologist · Boulder, CO
Provider details
- NPI number
- 1487192076
- Entity type
- Organization
- Primary specialty
- Clinical NeuropsychologistBehavioral Health & Social Service Providers
- Authorized official
- Bobby Gant, President
- License
- 2998 (CO)
Practice location
255 Canyon Blvd Ste 300-F
Boulder, CO 80302-4979
Phone: (972) 570-8200
Fax: (972) 402-5621
Mailing address
5455 Lee Hill Dr
Boulder, CO 80302-9305
Registry dates
- Enumerated
- 2017-02-03
- Last updated
- 2019-01-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.