MEDICARE: NORTHFORK SPEECH & HEARING PC

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	231H00000X	Audiologist	578	CO

General Provider Information

NPI Number	:	1881964401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHFORK SPEECH & HEARING PC

Provider Business Mailing Address
First Line	:	373 W DRAKE RD STE 5A
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2832
Country	:	US
Telephone Number	:	970-449-4110
Fax Number	:	970-449-4119

Provider Business Practice Location Address
First Line	:	373 W DRAKE RD STE 5A
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2832
Country	:	US
Telephone Number	:	970-449-4110
Fax Number	:	970-449-4119

Authorized Official
Title or Position	:	OWNER
Name	:	LORI L ARCHIE
Credential	:	AU.D.
Telephone Number	:	307-322-3332

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	02/26/2013

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