Healthcare Provider Details

I. General information

NPI: 1932329364
Provider Name (Legal Business Name): MRS. ELIZABETH KELEHER OBOURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7158 S MAGNOLIA CIR
CENTENNIAL CO
80112-6044
US

IV. Provider business mailing address

7158 S MAGNOLIA CIR
CENTENNIAL CO
80112-6044
US

V. Phone/Fax

Practice location:
  • Phone: 720-482-3879
  • Fax:
Mailing address:
  • Phone: 720-482-3879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number01046398
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: