Healthcare Provider Details

I. General information

NPI: 1609170141
Provider Name (Legal Business Name): MARY KATHERINE MOSHER-STATHES LSLS CERT AVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2010
Last Update Date: 12/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 SAINT PAUL ST
DENVER CO
80206-4336
US

IV. Provider business mailing address

441 SAINT PAUL ST
DENVER CO
80206-4336
US

V. Phone/Fax

Practice location:
  • Phone: 303-257-5943
  • Fax:
Mailing address:
  • Phone: 303-257-5943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number0454429
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number70712246
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: