Healthcare Provider Details

I. General information

NPI: 1750374211
Provider Name (Legal Business Name): LEE ANN LIZZUL M.S, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 EL CAMINO DR STE 200
COLORADO SPRINGS CO
80918-2104
US

IV. Provider business mailing address

5014 EL CAMINO DR STE 200
COLORADO SPRINGS CO
80918-2104
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-4100
  • Fax: 719-358-5299
Mailing address:
  • Phone: 719-633-4100
  • Fax: 719-358-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number90
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: