Provider Demographics
NPI:1356401814
Name:IVANICH, BOBBIE JO (RCII)
Entity type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JO
Last Name:IVANICH
Suffix:
Gender:F
Credentials:RCII
Other - Prefix:MRS
Other - First Name:BOBBIE
Other - Middle Name:JO
Other - Last Name:BUTALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13029 S STUART WAY
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7480
Mailing Address - Country:US
Mailing Address - Phone:303-840-4642
Mailing Address - Fax:
Practice Address - Street 1:1730 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1125
Practice Address - Country:US
Practice Address - Phone:303-840-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health