Healthcare Provider Details

I. General information

NPI: 1801339767
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF COLORADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 KITTREDGE LOOP ROAD 409 UCB
BOULDER CO
80309-0001
US

IV. Provider business mailing address

2501 KITTREDGE LOOP ROAD 409 UCB
BOULDER CO
80309-0001
US

V. Phone/Fax

Practice location:
  • Phone: 303-492-3066
  • Fax: 303-492-6560
Mailing address:
  • Phone: 303-492-3066
  • Fax: 303-492-6560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. SHELLEY SHEPPECK
Title or Position: ADMINISTRATOR
Credential: MA
Phone: 303-492-3066