Provider Demographics
NPI:1548255565
Name:ACKERMAN, JOYCE SHOET (EDD)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:SHOET
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 25TH AVE
Mailing Address - Street 2:101
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4943
Mailing Address - Country:US
Mailing Address - Phone:970-353-3373
Mailing Address - Fax:970-353-3374
Practice Address - Street 1:1750 25TH AVE
Practice Address - Street 2:101
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4943
Practice Address - Country:US
Practice Address - Phone:970-353-3373
Practice Address - Fax:970-353-3374
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA3506Medicare ID - Type Unspecified