MEDICARE: MS. LARA BETH SHEETS M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	00545640	CO

General Provider Information

NPI Number	:	1295008928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LARA BETH SHEETS M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1045 ROBERTSON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3926
Country	:	US
Telephone Number	:	970-493-6667
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 ROBERTSON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3926
Country	:	US
Telephone Number	:	970-493-6667
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	03/15/2026

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