Healthcare Provider Details

I. General information

NPI: 1316348139
Provider Name (Legal Business Name): MS. KELLEY CORCORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 08/08/2023
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 CHAPEL HILLS DR STE 325
COLORADO SPRINGS CO
80920-1061
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-4120
  • Fax: 719-364-4171
Mailing address:
  • Phone: 970-624-2417
  • Fax: 970-490-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1809
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD.0001120
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: